MEDICARE: ASHTON CONRAD

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	2355S0801X	Speech-Language Assistant	13-006	AR

General Provider Information

NPI Number	:	1659612844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHTON CONRAD

Provider Business Mailing Address
First Line	:	1104 FAWNWOOD RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72227-5934
Country	:	US
Telephone Number	:	662-401-9445
Fax Number	:

Provider Business Practice Location Address
First Line	:	9101 KANIS RD
Second Line	:	SUITE 201
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-6456
Country	:	US
Telephone Number	:	501-537-0158
Fax Number	:

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

Provider Enumeration Date	:	03/13/2013
Last Update Date	:	03/13/2013

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Directions to “ ASHTON CONRAD ” Practice Location

Language	Start Address	Practice Location

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