Provider Demographics
NPI:1588779813
Name:RONIS, LEE-ELLEN T (CCC-A)
Entity type:Individual
Prefix:
First Name:LEE-ELLEN
Middle Name:T
Last Name:RONIS
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11329 MARCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3633
Mailing Address - Country:US
Mailing Address - Phone:301-571-2175
Mailing Address - Fax:
Practice Address - Street 1:808 LANDMARK DR STE 808
Practice Address - Street 2:GLEN BURNIE OUTPATIENT CLINC
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4983
Practice Address - Country:US
Practice Address - Phone:410-590-4140
Practice Address - Fax:410-590-4159
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00468231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist