Provider Demographics
NPI:1396321436
Name:BOSLER, ELLA CORRINE (MCD, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELLA
Middle Name:CORRINE
Last Name:BOSLER
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:ELLA
Other - Middle Name:CORRINE
Other - Last Name:MCDANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:411 W POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946-1425
Mailing Address - Country:US
Mailing Address - Phone:618-273-7637
Mailing Address - Fax:
Practice Address - Street 1:411 W POPLAR ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:IL
Practice Address - Zip Code:62946-1425
Practice Address - Country:US
Practice Address - Phone:618-273-7637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22007135A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist