| Doctor Name: | MRS. KELLI KATHARINA ELLENBAUM |
| NPI Number: | 1003934878 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS |
| License Number: | 862 |
| Business Practice Address: | 210 S 12th St Bismarck, ND - 585045622 |
| Business Phone Number: | 7012223175 |
| Business Fax Number: | 7012223186 |
| Mailing Address: | 210 S 12th St, BISMARCK |
| State: | ND |
| Postal Code: | 585045622 |
| Phone Number: | 7012223175 |
| Fax Number: | 7012223186 |
| NPI Enumeration Date: | 03/27/2007 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 862 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ND |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |