Provider Demographics
NPI:1558646232
Name:ELDER, ASHLEY W (MED SLP)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:W
Last Name:ELDER
Suffix:
Gender:F
Credentials:MED SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 GUILFORD LN
Mailing Address - Street 2:
Mailing Address - City:NICHOLS HILLS
Mailing Address - State:OK
Mailing Address - Zip Code:73120-1013
Mailing Address - Country:US
Mailing Address - Phone:405-550-1860
Mailing Address - Fax:
Practice Address - Street 1:1705 GUILFORD LN
Practice Address - Street 2:
Practice Address - City:NICHOLS HILLS
Practice Address - State:OK
Practice Address - Zip Code:73120-1013
Practice Address - Country:US
Practice Address - Phone:405-550-1860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12025054235Z00000X
OK2728235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist