Healthcare Provider Details

I. General information

NPI: 1003434549
Provider Name (Legal Business Name): ASHLEY RUTHVEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY BENTLEY

II. Dates (important events)

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

III. Provider practice location address

4100 JACKSON AVE
AUSTIN TX
78731-6056
US

IV. Provider business mailing address

901 HIDDEN VALLEY DR APT 5102
ROUND ROCK TX
78665-1468
US

V. Phone/Fax

Practice location:
  • Phone: 512-454-4711
  • Fax:
Mailing address:
  • Phone: 210-852-7938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number116921
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: