Provider Demographics
NPI:1932238524
Name:ELLIS, SHERRILL G (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:SHERRILL
Middle Name:G
Last Name:ELLIS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:H
Other - Middle Name:SHERRILL
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:7 W PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4041
Mailing Address - Country:US
Mailing Address - Phone:203-777-7905
Mailing Address - Fax:
Practice Address - Street 1:7 W PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4041
Practice Address - Country:US
Practice Address - Phone:203-777-7905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00001964235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist