Provider Demographics
NPI:1467544676
Name:VERLO, ELLEN JEAN
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:JEAN
Last Name:VERLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 E 52ND ST
Mailing Address - Street 2:2
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2786
Mailing Address - Country:US
Mailing Address - Phone:563-355-7712
Mailing Address - Fax:563-359-1325
Practice Address - Street 1:2215 E 52ND ST
Practice Address - Street 2:2
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2786
Practice Address - Country:US
Practice Address - Phone:563-355-7712
Practice Address - Fax:563-359-1325
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAAUD-242 HA-434237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0040444Medicaid
IAI77150002Medicare UPIN