Provider Demographics
NPI:1588810774
Name:ELY, VIRGINIA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:ELY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9555 SAND SPRINGS CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:TN
Mailing Address - Zip Code:38574-3234
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9555 SAND SPRINGS CHURCH RD
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:TN
Practice Address - Zip Code:38574-3234
Practice Address - Country:US
Practice Address - Phone:931-839-2411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001582235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist