MEDICARE: MR. MARK JAMES ASHLEY CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	13407	TX

General Provider Information

NPI Number	:	1528396389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK JAMES ASHLEY CCC-SLP

Provider Business Mailing Address
First Line	:	1320 W WALNUT HILL LN
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-3007
Country	:	US
Telephone Number	:	972-580-8500
Fax Number	:	972-255-3162

Provider Business Practice Location Address
First Line	:	1320 W WALNUT HILL LN
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-3007
Country	:	US
Telephone Number	:	972-580-8500
Fax Number	:	972-255-3162

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2009
Last Update Date	:	12/08/2009

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