Provider Demographics
NPI:1306337803
Name:VAN METER, ELLEN MARY
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARY
Last Name:VAN METER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12025 TURNBERRY PARK LN
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-6026
Mailing Address - Country:US
Mailing Address - Phone:804-591-9397
Mailing Address - Fax:
Practice Address - Street 1:12025 TURNBERRY PARK LN
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-6026
Practice Address - Country:US
Practice Address - Phone:804-591-9397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005474235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist