Provider Demographics
NPI:1558098095
Name:CHILDRESS, WILL ELL ELIZABETH (MA, SLP)
Entity Type:Individual
Prefix:MS
First Name:WILL ELL
Middle Name:ELIZABETH
Last Name:CHILDRESS
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 SADIE AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-4844
Mailing Address - Country:US
Mailing Address - Phone:504-453-8212
Mailing Address - Fax:
Practice Address - Street 1:1 TIGER DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2046
Practice Address - Country:US
Practice Address - Phone:985-643-2992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8960235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist