Provider Demographics
NPI:1629257472
Name:STEVENS, ELLEN RUTH (HAD)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:RUTH
Last Name:STEVENS
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 SE SUNNYSIDE RD.
Mailing Address - Street 2:STE. 300-N
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5738
Mailing Address - Country:US
Mailing Address - Phone:503-659-5115
Mailing Address - Fax:303-438-9026
Practice Address - Street 1:6821 W. 120TH AVE.
Practice Address - Street 2:STE #2H
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-2355
Practice Address - Country:US
Practice Address - Phone:303-438-6633
Practice Address - Fax:303-438-9026
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO129237700000X
COHAD-129237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist