Provider Demographics
NPI:1376928341
Name:DENBIGH, ELLIE ROSE COURTNEY (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELLIE
Middle Name:ROSE COURTNEY
Last Name:DENBIGH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:ELLIE
Other - Middle Name:ROSE
Other - Last Name:COURTNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, INTERN-SLP
Mailing Address - Street 1:8211 POPLAR CT
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77523-0869
Mailing Address - Country:US
Mailing Address - Phone:713-885-4551
Mailing Address - Fax:
Practice Address - Street 1:5313 DECKER DR
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-1413
Practice Address - Country:US
Practice Address - Phone:281-838-4477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111474235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
13592643OtherCAQH PROVIDER ID
TX349114402Medicaid
TX349114401Medicaid