Provider Demographics
NPI:1154873982
Name:BREDER, ELLANA (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ELLANA
Middle Name:
Last Name:BREDER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:ELLANA
Other - Middle Name:
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:24 STATION AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-2719
Mailing Address - Country:US
Mailing Address - Phone:917-939-9577
Mailing Address - Fax:
Practice Address - Street 1:2221 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3920
Practice Address - Country:US
Practice Address - Phone:718-475-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025174-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist