Provider Demographics
NPI:1063604528
Name:HORVATH, ELLEN M (MA, CCC-SP)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:HORVATH
Suffix:
Gender:F
Credentials:MA, CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12777 VALLEY VIEW, SUITE 212
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845
Mailing Address - Country:US
Mailing Address - Phone:714-301-0048
Mailing Address - Fax:
Practice Address - Street 1:12777 VALLEY VIEW ST STE 212
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-2522
Practice Address - Country:US
Practice Address - Phone:714-301-0048
Practice Address - Fax:714-963-7633
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1040235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP1040OtherGROUP INSURANCES