Provider Demographics
NPI:1457875684
Name:HOTARD, ASHTON M (SLP)
Entity Type:Individual
Prefix:
First Name:ASHTON
Middle Name:M
Last Name:HOTARD
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 1:916 BELMONT ST STE 1
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-3817
Mailing Address - Country:US
Mailing Address - Phone:601-852-3271
Mailing Address - Fax:601-738-5842
Practice Address - Street 1:916 BELMONT ST STE 1
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-3817
Practice Address - Country:US
Practice Address - Phone:601-852-3271
Practice Address - Fax:601-738-5842
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-31
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS4338235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04306257Medicaid