Provider Demographics
NPI:1215046107
Name:HODGE, ASHLEY S (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:S
Last Name:HODGE
Suffix:
Gender:F
Credentials:MS 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:PO BOX 1377
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71294
Mailing Address - Country:US
Mailing Address - Phone:318-396-1969
Mailing Address - Fax:318-396-1970
Practice Address - Street 1:107 SUMMER LANE
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291
Practice Address - Country:US
Practice Address - Phone:318-396-1969
Practice Address - Fax:318-396-1969
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5143235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5C869Medicare ID - Type UnspecifiedGROUP