Provider Demographics
NPI:1063735025
Name:MUURRAY, ELLEN M (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:M
Last Name:MUURRAY
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 1:16 ELM CT
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916-2605
Mailing Address - Country:US
Mailing Address - Phone:401-633-2717
Mailing Address - Fax:
Practice Address - Street 1:16 ELM CT
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:RI
Practice Address - Zip Code:02916-2605
Practice Address - Country:US
Practice Address - Phone:401-633-2717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP01016235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RISP01016OtherLICENSE IN SPEECH LANGUAGE PATHOLOGY