Provider Demographics
NPI:1831336650
Name:DAVIS, ASHLEY BERTRAND (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:BERTRAND
Last Name:DAVIS
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:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70511-0206
Mailing Address - Country:US
Mailing Address - Phone:337-523-4822
Mailing Address - Fax:
Practice Address - Street 1:214 JEFFERSON ST
Practice Address - Street 2:SUITE #301
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-7050
Practice Address - Country:US
Practice Address - Phone:337-523-4822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5778235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist