Provider Demographics
NPI:1679957419
Name:ELLINGSEN SPEECH THERAPY, LLC
Entity Type:Organization
Organization Name:ELLINGSEN SPEECH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:QUINN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLINGSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:503-564-0565
Mailing Address - Street 1:8050 SW WARM SPRINGS ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-7424
Mailing Address - Country:US
Mailing Address - Phone:503-564-0565
Mailing Address - Fax:
Practice Address - Street 1:8050 SW WARM SPRINGS ST
Practice Address - Street 2:SUITE 130
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-7424
Practice Address - Country:US
Practice Address - Phone:503-564-0565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
1568718013OtherPERSONAL PROVIDER NPI
1386054625OtherPERSONAL PROVIDER NPI