Provider Demographics
NPI:1336399500
Name:ASHURST, CONSTANCE PARKER (CCC/SLP)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:PARKER
Last Name:ASHURST
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:CONSTANCE
Other - Middle Name:AIREY
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFY
Mailing Address - Street 1:4529 W AMHERST AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-3123
Mailing Address - Country:US
Mailing Address - Phone:214-418-8995
Mailing Address - Fax:
Practice Address - Street 1:1201 E 15TH ST STE 304
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-6246
Practice Address - Country:US
Practice Address - Phone:972-424-0148
Practice Address - Fax:972-422-5275
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103592235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist