Provider Demographics
NPI:1073036604
Name:ELLIE SPEECH THERAPY
Entity Type:Organization
Organization Name:ELLIE SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAG PATHOLOGIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:
Authorized Official - Last Name:SEQUEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:832-566-3033
Mailing Address - Street 1:92 NW 93RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33150-2233
Mailing Address - Country:US
Mailing Address - Phone:832-566-3033
Mailing Address - Fax:305-203-1229
Practice Address - Street 1:92 NW 93RD ST
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33150-2233
Practice Address - Country:US
Practice Address - Phone:832-566-3033
Practice Address - Fax:305-203-1229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12353235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty