Provider Demographics
NPI:1407160302
Name:ELLISON, EVE M (MSCCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:EVE
Middle Name:M
Last Name:ELLISON
Suffix:
Gender:F
Credentials:MSCCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 BOYDS CORNER RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03908-2010
Mailing Address - Country:US
Mailing Address - Phone:207-676-7990
Mailing Address - Fax:
Practice Address - Street 1:388 SOMERSWORTH RD
Practice Address - Street 2:
Practice Address - City:NORTH BERWICK
Practice Address - State:ME
Practice Address - Zip Code:03906-6559
Practice Address - Country:US
Practice Address - Phone:207-676-2843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP783235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist