Provider Demographics
NPI:1710345806
Name:SERVIA, ELLIE MARIE (AUD)
Entity Type:Individual
Prefix:DR
First Name:ELLIE
Middle Name:MARIE
Last Name:SERVIA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 UNIVERSITY LAKE DR STE 220
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4658
Mailing Address - Country:US
Mailing Address - Phone:907-202-1238
Mailing Address - Fax:
Practice Address - Street 1:3801 UNIVERSITY LAKE DR STE 220
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-729-8844
Practice Address - Fax:907-729-1474
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK106954231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist