Provider Demographics
NPI:1396978300
Name:SELLERS, ASHELEY DELOIS (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ASHELEY
Middle Name:DELOIS
Last Name:SELLERS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:SPEECH
Other - Middle Name:LANGUAGE AND
Other - Last Name:BEYOND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:514 DIVINE DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-9547
Mailing Address - Country:US
Mailing Address - Phone:229-638-0627
Mailing Address - Fax:229-496-5277
Practice Address - Street 1:235 W ROOSEVELT AVE STE 226
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-5131
Practice Address - Country:US
Practice Address - Phone:229-638-0627
Practice Address - Fax:229-329-4487
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007125235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA844552268AMedicaid
GA844552268BMedicaid