Provider Demographics
NPI:1578038394
Name:HODGE, ASHLEN (MA60886665)
Entity type:Individual
Prefix:
First Name:ASHLEN
Middle Name:
Last Name:HODGE
Suffix:
Gender:
Credentials:MA60886665
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 FERN ST SW APT M203
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-1004
Mailing Address - Country:US
Mailing Address - Phone:509-859-4943
Mailing Address - Fax:
Practice Address - Street 1:113 5TH AVE SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1121
Practice Address - Country:US
Practice Address - Phone:509-859-4943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-08
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAM60886665225700000X
WAMA60886665225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty