Healthcare Provider Details

I. General information

NPI: 1659612844
Provider Name (Legal Business Name): ASHTON CONRAD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2013
Last Update Date: 03/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 KANIS RD SUITE 201
LITTLE ROCK AR
72205-6456
US

IV. Provider business mailing address

1104 FAWNWOOD RD
LITTLE ROCK AR
72227-5934
US

V. Phone/Fax

Practice location:
  • Phone: 501-537-0158
  • Fax:
Mailing address:
  • Phone: 662-401-9445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number13-006
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: