Provider Demographics
NPI:1477005684
Name:ROWBERRY, ELLEN (MS, CCC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:ROWBERRY
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-6041
Mailing Address - Country:US
Mailing Address - Phone:315-402-0093
Mailing Address - Fax:
Practice Address - Street 1:120 E 1ST ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2111
Practice Address - Country:US
Practice Address - Phone:315-341-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026251251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)