Provider Demographics
NPI:1023575594
Name:NELSON, ASHLEA (MCD, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ASHLEA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 VIKING DR STE 200
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-7511
Mailing Address - Country:US
Mailing Address - Phone:318-746-1199
Mailing Address - Fax:
Practice Address - Street 1:4440 VIKING DR STE 200
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-7511
Practice Address - Country:US
Practice Address - Phone:318-746-1199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7945235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist