Provider Demographics
NPI:1225237290
Name:HEMRICK, ELLEN T (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:T
Last Name:HEMRICK
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 1:731 106TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-1849
Mailing Address - Country:US
Mailing Address - Phone:617-872-1030
Mailing Address - Fax:
Practice Address - Street 1:681 GOODLETTE RD N
Practice Address - Street 2:SUITE 150
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5458
Practice Address - Country:US
Practice Address - Phone:239-434-9512
Practice Address - Fax:239-643-5908
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9334235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000913200Medicaid