Provider Demographics
NPI:1528396389
Name:ASHLEY, MARK JAMES (CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:JAMES
Last Name:ASHLEY
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 W WALNUT HILL LN
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3007
Mailing Address - Country:US
Mailing Address - Phone:972-580-8500
Mailing Address - Fax:972-255-3162
Practice Address - Street 1:1320 W WALNUT HILL LN
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-3007
Practice Address - Country:US
Practice Address - Phone:972-580-8500
Practice Address - Fax:972-255-3162
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-05
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13407235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist