Provider Demographics
NPI:1699924852
Name:WEINBAUM, ELLEN L (CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:L
Last Name:WEINBAUM
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:MO
Mailing Address - Zip Code:65559-0506
Mailing Address - Country:US
Mailing Address - Phone:573-265-0436
Mailing Address - Fax:
Practice Address - Street 1:17599 HIGHWAY 8
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MO
Practice Address - Zip Code:65559-8227
Practice Address - Country:US
Practice Address - Phone:573-265-0436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111656235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist