Provider Demographics
NPI:1184195364
Name:ELLER, ASHLEE ANNE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ASHLEE
Middle Name:ANNE
Last Name:ELLER
Suffix:
Gender:F
Credentials:MS 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:PO BOX 395
Mailing Address - Street 2:
Mailing Address - City:GLENDO
Mailing Address - State:WY
Mailing Address - Zip Code:82213-0395
Mailing Address - Country:US
Mailing Address - Phone:307-331-1542
Mailing Address - Fax:
Practice Address - Street 1:150 CARING WAY
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3410
Practice Address - Country:US
Practice Address - Phone:307-332-5560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYSP-795235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA