Provider Demographics
NPI:1073837878
Name:MARTIN, ELLEN CROSBY ROU (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:CROSBY ROU
Last Name:MARTIN
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 1:7522 WILES RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2062
Mailing Address - Country:US
Mailing Address - Phone:954-227-8255
Mailing Address - Fax:954-227-8255
Practice Address - Street 1:7522 WILES RD
Practice Address - Street 2:SUITE 207
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-2062
Practice Address - Country:US
Practice Address - Phone:954-227-8255
Practice Address - Fax:954-227-8255
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10302235Z00000X
GASLP006443235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA10302OtherSTATE LICENSE