Provider Demographics
NPI:1396989661
Name:ELLIOTT, ELLEN KIMBERLY (MED SLP)
Entity type:Individual
Prefix:MISS
First Name:ELLEN
Middle Name:KIMBERLY
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MED SLP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12736 GOLF CLUB DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-2614
Mailing Address - Country:US
Mailing Address - Phone:912-695-5460
Mailing Address - Fax:
Practice Address - Street 1:12736 GOLF CLUB DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-2614
Practice Address - Country:US
Practice Address - Phone:912-695-5460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4431235Z00000X
GASLP007230235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist