Provider Demographics
NPI:1942367917
Name:FOWLER, ASHLEY RACHELLE (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:RACHELLE
Last Name:FOWLER
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5120 FOGGY RIVER LN
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38135-6261
Mailing Address - Country:US
Mailing Address - Phone:901-596-2747
Mailing Address - Fax:901-509-2704
Practice Address - Street 1:5120 FOGGY RIVER LN
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38135-6261
Practice Address - Country:US
Practice Address - Phone:901-596-2747
Practice Address - Fax:901-509-2704
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2106235Z00000X
TNSP0000004043235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150401721Medicaid
260078OtherMEDICARE PROVIDER NUMBER ISSUED IN 2003
TNSP 4043OtherBOARD OF COMMUNICATION DISORDERS AND SCIENCES
TNQ005590OtherTENNESSEE TENNCARE/MEDICAID
12093824OtherAMERCIAN SPEECH-LANGUAGE HEARING ASSOCIATION (ASHA)