Provider Demographics
NPI:1356667810
Name:KNOWLES, ELLEN JULIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:JULIE
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9118 DONNA DEAN DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22153
Mailing Address - Country:US
Mailing Address - Phone:703-912-4805
Mailing Address - Fax:
Practice Address - Street 1:9118 DONNA DEAN DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22153-1420
Practice Address - Country:US
Practice Address - Phone:703-912-4805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005625235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist