Provider Demographics
NPI:1306127980
Name:ELLINGSON, JEANNINE MARIE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JEANNINE
Middle Name:MARIE
Last Name:ELLINGSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 MEADOW HILL RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-3878
Mailing Address - Country:US
Mailing Address - Phone:845-568-6600
Mailing Address - Fax:
Practice Address - Street 1:124 MEADOW HILL RD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3878
Practice Address - Country:US
Practice Address - Phone:845-568-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014306-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist