Provider Demographics
NPI:1629304027
Name:ENNIS, RYANN VANESSA (SPEECH/LANGUAGE PATH)
Entity Type:Individual
Prefix:
First Name:RYANN
Middle Name:VANESSA
Last Name:ENNIS
Suffix:
Gender:F
Credentials:SPEECH/LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 MAR WALT DRIVE
Mailing Address - Street 2:OTOLARYNGOLOGY DEPARTMENT
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6796
Mailing Address - Country:US
Mailing Address - Phone:850-863-8275
Mailing Address - Fax:850-314-6833
Practice Address - Street 1:1005 MAR WALT DRIVE
Practice Address - Street 2:OTOLARYNGOLOGY DEPARTMENT
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6796
Practice Address - Country:US
Practice Address - Phone:850-863-8275
Practice Address - Fax:850-314-6833
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8416235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist