Provider Demographics
NPI:1235561424
Name:ELLIS, SCARLETT TAYLOR (SLP)
Entity Type:Individual
Prefix:MISS
First Name:SCARLETT
Middle Name:TAYLOR
Last Name:ELLIS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 NW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:TX
Mailing Address - Zip Code:79714-5014
Mailing Address - Country:US
Mailing Address - Phone:432-524-3640
Mailing Address - Fax:325-617-7809
Practice Address - Street 1:405 NW 3RD ST
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:TX
Practice Address - Zip Code:79714-5014
Practice Address - Country:US
Practice Address - Phone:432-524-3640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX371392355S0801X
TX109018235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant