Provider Demographics
NPI:1679836670
Name:ELLISON, CAMERON LEE (HIS, COHC)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:LEE
Last Name:ELLISON
Suffix:
Gender:M
Credentials:HIS, COHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 N DIERS AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4957
Mailing Address - Country:US
Mailing Address - Phone:308-395-8107
Mailing Address - Fax:
Practice Address - Street 1:819 N DIERS AVE STE 1
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4957
Practice Address - Country:US
Practice Address - Phone:308-395-8107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE787237700000X
NE900783237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist