Provider Demographics
NPI:1184018343
Name:ELLIS, DAWN CARROLL (PHD, CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:CARROLL
Last Name:ELLIS
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 16TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-3116
Mailing Address - Country:US
Mailing Address - Phone:202-277-1829
Mailing Address - Fax:
Practice Address - Street 1:4901 16TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-3116
Practice Address - Country:US
Practice Address - Phone:202-277-1829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCSLP000873235Z00000X
MD05458235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist