Provider Demographics
NPI:1942841523
Name:ANDERSON, ASHLI BROOKE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ASHLI
Middle Name:BROOKE
Last Name:ANDERSON
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 1:13813 HUTCHINSON PL
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-1351
Mailing Address - Country:US
Mailing Address - Phone:405-824-7242
Mailing Address - Fax:
Practice Address - Street 1:13813 HUTCHINSON PL
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-1351
Practice Address - Country:US
Practice Address - Phone:405-824-7242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3330235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty