Provider Demographics
NPI:1770815904
Name:SHAFFER, ASHLEY (SLP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:SHAFFER
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 1:1400 BAYFIELD ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76209-3550
Mailing Address - Country:US
Mailing Address - Phone:817-648-8308
Mailing Address - Fax:
Practice Address - Street 1:1400 BAYFIELD ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76209-3550
Practice Address - Country:US
Practice Address - Phone:817-648-8308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-15
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116070235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111408402Medicaid
TX111408402Medicaid