Provider Demographics
NPI:1619104775
Name:SPEAR, ELLEN FOX (MA, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:FOX
Last Name:SPEAR
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 CROCKER RD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145
Mailing Address - Country:US
Mailing Address - Phone:440-471-7190
Mailing Address - Fax:480-287-8108
Practice Address - Street 1:815 CROCKER RD
Practice Address - Street 2:SUITE #3
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145
Practice Address - Country:US
Practice Address - Phone:440-471-7190
Practice Address - Fax:480-287-8108
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP5229235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist