Provider Demographics
NPI:1750585451
Name:FURR, ASHLEY NICOLE (SLP)
Entity type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:NICOLE
Last Name:FURR
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 1:605 HAZELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-5607
Mailing Address - Country:US
Mailing Address - Phone:704-796-6648
Mailing Address - Fax:
Practice Address - Street 1:1404 S SALISBURY AVE
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:NC
Practice Address - Zip Code:28159-1921
Practice Address - Country:US
Practice Address - Phone:704-637-5175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6051235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC235Z00000XMedicare ID - Type UnspecifiedSLP