MEDICARE: MS. ASHLEY RACHELLE FOWLER MCD, 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	2106	AR
2	235Z00000X	Speech-Language Pathologist	SP0000004043	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	260078	OTHER		MEDICARE PROVIDER NUMBER ISSUED IN 2003

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	SP 4043	OTHER	TN	BOARD OF COMMUNICATION DISORDERS AND SCIENCES
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	12093824	OTHER		AMERCIAN SPEECH-LANGUAGE HEARING ASSOCIATION (ASHA)

General Provider Information

NPI Number	:	1942367917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ASHLEY RACHELLE FOWLER MCD, CCC-SLP

Provider Business Mailing Address
First Line	:	5120 FOGGY RIVER LN
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38135-6261
Country	:	US
Telephone Number	:	901-596-2747
Fax Number	:	901-509-2704

Provider Business Practice Location Address
First Line	:	5120 FOGGY RIVER LN
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38135-6261
Country	:	US
Telephone Number	:	901-596-2747
Fax Number	:	901-509-2704

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

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	07/23/2014

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Directions to “ MS. ASHLEY RACHELLE FOWLER MCD, CCC-SLP” Practice Location

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