Provider Demographics
NPI:1215499447
Name:ELLENBECKER AND BORSELLINO PLLC
Entity type:Organization
Organization Name:ELLENBECKER AND BORSELLINO PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:ELLENBECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:615-596-1830
Mailing Address - Street 1:1994 GALLATIN PIKE N STE 202
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-2024
Mailing Address - Country:US
Mailing Address - Phone:615-596-1830
Mailing Address - Fax:615-766-8277
Practice Address - Street 1:1994 GALLATIN PIKE N STE 202
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-2024
Practice Address - Country:US
Practice Address - Phone:615-596-1830
Practice Address - Fax:615-766-8277
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELLENBECKER AND BORSELLINO PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-05
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1457518417Medicaid