Individual
MS. ASHLEY RACHELLE FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MCD, CCC-SLP
Contact information
Practice address
5120 FOGGY RIVER LN, BARTLETT, TN 38135-6261
(901) 596-2747
(901) 509-2704
Mailing address
5120 FOGGY RIVER LN, BARTLETT, TN 38135-6261
(901) 596-2747
(901) 509-2704
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
2106
AR
235Z00000X
Speech-Language Pathologist
Primary
SP0000004043
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12093824
AMERCIAN SPEECH-LANGUAGE HEARING ASSOCIATION (ASHA)
—
05
—
150401721
—
AR
01
—
260078
MEDICARE PROVIDER NUMBER ISSUED IN 2003
—
01
—
Q005590
TENNESSEE TENNCARE/MEDICAID
TN
01
—
SP 4043
BOARD OF COMMUNICATION DISORDERS AND SCIENCES
TN
Enumeration date
01/02/2007
Last updated
07/23/2014
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