MEDICARE: ASHLEY HEROUT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1003514878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY HEROUT

Provider Business Mailing Address
First Line	:	60588 TOWN SQUARE ST
Second Line	:
City	:	NEW HUDSON
State	:	MI
Zip	:	48165-9652
Country	:	US
Telephone Number	:	248-756-5193
Fax Number	:

Provider Business Practice Location Address
First Line	:	6105 W ST JOE HWY STE 211
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48917-4850
Country	:	US
Telephone Number	:	888-619-9135
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2023
Last Update Date	:	02/21/2023

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Directions to “ ASHLEY HEROUT ” Practice Location

Language	Start Address	Practice Location

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