Provider Demographics
NPI:1801074687
Name:THORNTON, ASHLEIGH GREEN
Entity type:Individual
Prefix:MRS
First Name:ASHLEIGH
Middle Name:GREEN
Last Name:THORNTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:982 MARCO DR NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2727
Mailing Address - Country:US
Mailing Address - Phone:727-244-7472
Mailing Address - Fax:727-521-6020
Practice Address - Street 1:982 MARCO DR NE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-2727
Practice Address - Country:US
Practice Address - Phone:727-244-7472
Practice Address - Fax:727-521-6020
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5897235Z00000X
FLSA 5897103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities