Provider Demographics
NPI:1336290659
Name:ELLEDGE, PATTI (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PATTI
Middle Name:
Last Name:ELLEDGE
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 1:10 AZALEA ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2814
Mailing Address - Country:US
Mailing Address - Phone:828-273-0323
Mailing Address - Fax:
Practice Address - Street 1:25 ORANGE ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2328
Practice Address - Country:US
Practice Address - Phone:828-273-0323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6236235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist