Basic Information
| Provider Information | |||||||||
| NPI: | 1124463765 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLOODSWORTH | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS, CCC-SLP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JAMES | ||||||||
| OtherFirstName: | ASHLEY | ||||||||
| OtherMiddleName: | ELIZABETH | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MS, CCC-SLP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 300 FAULKNER DRIVE | ||||||||
| Address2: | |||||||||
| City: | BAY MINETTE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 365324453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2519379881 | ||||||||
| FaxNumber: | 2519379804 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 FAULKNER DR | ||||||||
| Address2: | |||||||||
| City: | BAY MINETTE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 365072771 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2519379881 | ||||||||
| FaxNumber: | 2519379804 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2013 | ||||||||
| LastUpdateDate: | 05/14/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 3451 | AL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.