Provider Demographics
NPI:1750446142
Name:LEDESMA, ELLEN MARIE (MHS)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARIE
Last Name:LEDESMA
Suffix:
Gender:F
Credentials:MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 GRAPE VINE TRL
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-6017
Mailing Address - Country:US
Mailing Address - Phone:630-661-7253
Mailing Address - Fax:855-765-7549
Practice Address - Street 1:470 GRAPE VINE TRL
Practice Address - Street 2:SUITE 100
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-6017
Practice Address - Country:US
Practice Address - Phone:630-661-7253
Practice Address - Fax:855-765-7549
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.010079235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist