Healthcare Provider Details

I. General information

NPI: 1073265690
Provider Name (Legal Business Name): ASHLYNN ECCLESTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 SANGER AVE
WACO TX
76710-5866
US

IV. Provider business mailing address

127 W BROAD ST STE 850
LAKE CHARLES LA
70601-4394
US

V. Phone/Fax

Practice location:
  • Phone: 254-848-6284
  • Fax: 254-848-4193
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: