Provider Demographics
NPI:1235610932
Name:BLACKWELL, BREE ELLESSE (AUD)
Entity Type:Individual
Prefix:DR
First Name:BREE
Middle Name:ELLESSE
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 STEPHENSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5923
Mailing Address - Country:US
Mailing Address - Phone:912-352-8530
Mailing Address - Fax:
Practice Address - Street 1:527 STEPHENSON AVE UNIT A-3
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5923
Practice Address - Country:US
Practice Address - Phone:912-352-8530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD004144237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter