Provider Demographics
NPI:1275738478
Name:PANNELL, ASHLEY BROOKE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:BROOKE
Last Name:PANNELL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17706 INTERSTATE 30 STE 3
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-2930
Mailing Address - Country:US
Mailing Address - Phone:501-315-4414
Mailing Address - Fax:501-315-3467
Practice Address - Street 1:17706 INTERSTATE 30 STE 3
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-2930
Practice Address - Country:US
Practice Address - Phone:501-315-4414
Practice Address - Fax:501-315-3467
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#2454235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist