Provider Demographics
NPI:1851595375
Name:STOWELL, ELLEN LARSON (MS-CCC, SLP)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:LARSON
Last Name:STOWELL
Suffix:
Gender:F
Credentials:MS-CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 MOUNTAIN CREEK RD
Mailing Address - Street 2:SUITE 380
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-1687
Mailing Address - Country:US
Mailing Address - Phone:423-877-5042
Mailing Address - Fax:423-877-5046
Practice Address - Street 1:1200 MOUNTAIN CREEK RD
Practice Address - Street 2:SUITE 380
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-1687
Practice Address - Country:US
Practice Address - Phone:423-877-5046
Practice Address - Fax:423-877-5046
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5440985Medicaid