Provider Demographics
NPI:1558429712
Name:GARRETT, ELLEN GORDON (SLP)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:GORDON
Last Name:GARRETT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 NE 93RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2817
Mailing Address - Country:US
Mailing Address - Phone:305-751-6648
Mailing Address - Fax:305-758-1097
Practice Address - Street 1:149 NE 93RD ST
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2817
Practice Address - Country:US
Practice Address - Phone:305-751-6648
Practice Address - Fax:305-758-1097
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA1961235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist