Healthcare Provider Details

I. General information

NPI: 1457875684
Provider Name (Legal Business Name): ASHTON M HOTARD SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 BELMONT ST STE 1
VICKSBURG MS
39180-3817
US

IV. Provider business mailing address

916 BELMONT ST STE 1
VICKSBURG MS
39180-3817
US

V. Phone/Fax

Practice location:
  • Phone: 601-852-3271
  • Fax: 601-738-5842
Mailing address:
  • Phone: 601-852-3271
  • Fax: 601-738-5842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberS4338
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: