Provider Demographics
NPI:1902571896
Name:DOUGLAS, ASHLYN BROOKE (SLP)
Entity type:Individual
Prefix:
First Name:ASHLYN
Middle Name:BROOKE
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 IMPERIAL BLVD.
Mailing Address - Street 2:BLDG #3
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5393
Mailing Address - Country:US
Mailing Address - Phone:337-478-5880
Mailing Address - Fax:337-478-5879
Practice Address - Street 1:1727 IMPERIAL BLVD.
Practice Address - Street 2:BLDG #3
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5393
Practice Address - Country:US
Practice Address - Phone:281-838-4477
Practice Address - Fax:281-838-3465
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9386235Z00000X
TX116945235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116945OtherSLP LICENSE