Doctor Name: | ELLEN KELLOGG |
NPI Number: | 1053713131 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A.CCC-SLP |
License Number: | SA10093 |
Business Practice Address: | 393 Palm Coast Pkwy Sw Palm Coast, FL - 321374773 |
Business Phone Number: | 5852022745 |
Business Fax Number: | |
Mailing Address: | Po Box 748, FLAGLER BEACH |
State: | FL |
Postal Code: | 321360748 |
Phone Number: | 5852022745 |
Fax Number: | |
NPI Enumeration Date: | 09/21/2014 |
NPI Last Update Date: | 09/21/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SA10093 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
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 |