Provider Demographics
NPI:1033495155
Name:KALLEM, ELLEN (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:
Last Name:KALLEM
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SAUL PL
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-3020
Mailing Address - Country:US
Mailing Address - Phone:561-681-0289
Mailing Address - Fax:
Practice Address - Street 1:11 SAUL PL
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-3020
Practice Address - Country:US
Practice Address - Phone:561-681-0289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002036235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist