Provider Demographics
NPI:1083926927
Name:GEHL, ELLEN LOUISE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:LOUISE
Last Name:GEHL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4748 BUNKER RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-9781
Mailing Address - Country:US
Mailing Address - Phone:517-628-3813
Mailing Address - Fax:
Practice Address - Street 1:4748 BUNKER RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-9781
Practice Address - Country:US
Practice Address - Phone:517-628-3813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01006145OtherASHA