Provider Demographics
NPI:1710697859
Name:LIND, ELLISON ARLENE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELLISON
Middle Name:ARLENE
Last Name:LIND
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9939 SEA CREST LN
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:WA
Mailing Address - Zip Code:98232-9347
Mailing Address - Country:US
Mailing Address - Phone:360-630-8256
Mailing Address - Fax:
Practice Address - Street 1:9939 SEA CREST LN
Practice Address - Street 2:
Practice Address - City:BOW
Practice Address - State:WA
Practice Address - Zip Code:98232-9347
Practice Address - Country:US
Practice Address - Phone:360-630-8256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist