MEDICARE: ASHLEY SUE JENSON CCC-SLP

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		AR

General Provider Information

NPI Number	:	1225764368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY SUE JENSON CCC-SLP

Provider Business Mailing Address
First Line	:	1430 E SIEBENMORGEN RD
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72032-4045
Country	:	US
Telephone Number	:	479-597-6717
Fax Number	:

Provider Business Practice Location Address
First Line	:	14901 CANTRELL RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72223-4255
Country	:	US
Telephone Number	:	501-821-5459
Fax Number	:

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

Provider Enumeration Date	:	07/30/2022
Last Update Date	:	07/16/2024

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Directions to “ ASHLEY SUE JENSON CCC-SLP” Practice Location

Language	Start Address	Practice Location

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