Provider Demographics
NPI:1275606923
Name:SHEPHERD, ASHLEY DREW (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DREW
Last Name:SHEPHERD
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 1:801 BELLE RIVE DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-5012
Mailing Address - Country:US
Mailing Address - Phone:870-739-2223
Mailing Address - Fax:
Practice Address - Street 1:620 THOMPSON AVE
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-3257
Practice Address - Country:US
Practice Address - Phone:870-702-4911
Practice Address - Fax:870-702-6386
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2039235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154107721Medicaid