Provider Demographics
NPI:1912329061
Name:GELLINEAU, ELLEN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:GELLINEAU
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 1:101 METROPOLITAN AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-2158
Mailing Address - Country:US
Mailing Address - Phone:617-320-0552
Mailing Address - Fax:
Practice Address - Street 1:101 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:MA
Practice Address - Zip Code:01721-2158
Practice Address - Country:US
Practice Address - Phone:617-320-5522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2717235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist