Doctor Name: | JILLIAN L ELLISON |
NPI Number: | 1861525073 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CCCSLP |
License Number: | 14001506 |
Business Practice Address: | 80 Maddex Dr Shepherdstown, WV - 254434305 |
Business Phone Number: | 3048769422 |
Business Fax Number: | 3048766279 |
Mailing Address: | 27 Ritter Dr, MARTINSBURG |
State: | WV |
Postal Code: | 254017577 |
Phone Number: | 3045828098 |
Fax Number: | |
NPI Enumeration Date: | 03/14/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 14001506 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WV |
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 |