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General NPI Number Information
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NPI Number | 1295270684
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Entity Type | Individual
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Provider Name | ASHLEY ROYERRE TALLEY M.S. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 12/21/2016
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Last Update Date | 08/02/2018
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Provider Practice Location Address
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Address Line | 621 W CANAL ST
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City | PICAYUNE
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State | MS
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Zip | 39466
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Country | US
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Telephone | 601-889-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 1561 PENNSYLVANIA AVE
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City | SLIDELL
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State | LA
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Zip | 70458-3148
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Country | US
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Telephone | 901-310-0354
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP0000005518
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License Number State | TN
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