Provider Demographics
NPI:1477239812
Name:HALLETT, ELLIE KATHERINE (MS)
Entity Type:Individual
Prefix:MRS
First Name:ELLIE
Middle Name:KATHERINE
Last Name:HALLETT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:ELLIE
Other - Middle Name:KATHERINE
Other - Last Name:GORALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6680 ROSS RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGWATER
Mailing Address - State:NY
Mailing Address - Zip Code:14560-9645
Mailing Address - Country:US
Mailing Address - Phone:585-445-4995
Mailing Address - Fax:
Practice Address - Street 1:2350 ROUTE 63
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:NY
Practice Address - Zip Code:14572-9404
Practice Address - Country:US
Practice Address - Phone:585-728-2091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist