Provider Demographics
NPI:1376566406
Name:SLOAN, ELLEN (MS,CCC-A)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:
Last Name:SLOAN
Suffix:
Gender:F
Credentials:MS,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 S CONGRESS AVE
Mailing Address - Street 2:STE.107
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-5876
Mailing Address - Country:US
Mailing Address - Phone:561-742-7559
Mailing Address - Fax:561-742-7957
Practice Address - Street 1:1325 S CONGRESS AVE
Practice Address - Street 2:STE.107
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-5876
Practice Address - Country:US
Practice Address - Phone:561-742-7559
Practice Address - Fax:561-742-7957
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY685231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS1507OtherBLUE CROSS BLUE SHIELD
FLS1507ZMedicare ID - Type UnspecifiedMEDICARE