Provider Demographics
NPI:1306237581
Name:ELS, CHEYENNE (MS)
Entity type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:
Last Name:ELS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 COUNTY ROAD 130
Mailing Address - Street 2:
Mailing Address - City:LEDBETTER
Mailing Address - State:TX
Mailing Address - Zip Code:78946-7003
Mailing Address - Country:US
Mailing Address - Phone:979-716-7725
Mailing Address - Fax:
Practice Address - Street 1:2337 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GIDDINGS
Practice Address - State:TX
Practice Address - Zip Code:78942-1460
Practice Address - Country:US
Practice Address - Phone:979-542-2875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-10
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111010235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist