Provider Demographics
NPI:1114216322
Name:BELL, ELLEN R (MA,CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:R
Last Name:BELL
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 1:3164 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IN
Mailing Address - Zip Code:46034-9600
Mailing Address - Country:US
Mailing Address - Phone:317-491-2604
Mailing Address - Fax:
Practice Address - Street 1:3164 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IN
Practice Address - Zip Code:46034-9600
Practice Address - Country:US
Practice Address - Phone:317-491-2604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22001354A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist