Provider Demographics
NPI:1639595747
Name:ELLINGSON, BETTY (MS)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:ELLINGSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24
Mailing Address - Street 2:
Mailing Address - City:NORTHWOOD
Mailing Address - State:ND
Mailing Address - Zip Code:58267-0024
Mailing Address - Country:US
Mailing Address - Phone:218-779-5708
Mailing Address - Fax:
Practice Address - Street 1:208 N BERG ST
Practice Address - Street 2:BOX 24
Practice Address - City:NORTHWOOD
Practice Address - State:ND
Practice Address - Zip Code:58267-4016
Practice Address - Country:US
Practice Address - Phone:218-779-5708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1066235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist