MEDICARE: MRS. ASHLEY D BRAGG M.S., 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	22006038A	IN

General Provider Information

NPI Number	:	1326488198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ASHLEY D BRAGG M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	2610 EISENHOWER AVE
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46615-3421
Country	:	US
Telephone Number	:	574-286-9620
Fax Number	:

Provider Business Practice Location Address
First Line	:	2610 EISENHOWER AVE
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46615-3421
Country	:	US
Telephone Number	:	574-286-9620
Fax Number	:

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

Provider Enumeration Date	:	06/26/2013
Last Update Date	:	11/20/2014

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Directions to “ MRS. ASHLEY D BRAGG M.S., CCC-SLP” Practice Location

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