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General NPI Number Information
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NPI Number | 1306174354
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Entity Type | Individual
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Provider Name | ASHLEY MARIE MICKELSON SLP
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Gender | Female
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Dates
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Enumeration Date | 12/03/2009
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Last Update Date | 07/25/2023
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Provider Practice Location Address
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Address Line | 889 GORDON RD
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City | WHITEWRIGHT
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State | TX
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Zip | 75491-7102
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Country | US
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Telephone | 903-926-8456
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Fax |
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Provider Business Mailing Address
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Address Line | 1512 W KIRBY PL
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City | SHREVEPORT
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State | LA
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Zip | 71103-3822
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Country | US
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Telephone | 318-675-6262
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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 | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number | L-302053
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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 | 6440
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License Number State | LA
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