Provider Demographics
NPI:1831242932
Name:RENNELS, ASHLEY BROOKE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:BROOKE
Last Name:RENNELS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10505 LONE PINE LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-3713
Mailing Address - Country:US
Mailing Address - Phone:817-565-8213
Mailing Address - Fax:
Practice Address - Street 1:350 KELLER PKWY
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-2249
Practice Address - Country:US
Practice Address - Phone:817-744-4528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103623235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist