Provider Demographics
NPI:1326569195
Name:FELIX, JO ELLEN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:ELLEN
Last Name:FELIX
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:JO
Other - Middle Name:ELLEN
Other - Last Name:ANDERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:1450 TREAT BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-2168
Mailing Address - Country:US
Mailing Address - Phone:925-952-2828
Mailing Address - Fax:
Practice Address - Street 1:350 JOHN MUIR PKWY STE 250
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-5194
Practice Address - Country:US
Practice Address - Phone:925-308-8636
Practice Address - Fax:925-308-8760
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-03
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16687235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist