Provider Demographics
NPI:1326488198
Name:BRAGG, ASHLEY D (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:D
Last Name:BRAGG
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 1:2610 EISENHOWER AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46615-3421
Mailing Address - Country:US
Mailing Address - Phone:574-286-9620
Mailing Address - Fax:
Practice Address - Street 1:2610 EISENHOWER AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615-3421
Practice Address - Country:US
Practice Address - Phone:574-286-9620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22006038A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist