Provider Demographics
NPI:1780858100
Name:KABATH, ELLEN D (CCC-A)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:D
Last Name:KABATH
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 SE OCEAN BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-3341
Mailing Address - Country:US
Mailing Address - Phone:772-220-8459
Mailing Address - Fax:772-600-1744
Practice Address - Street 1:2221 SE OCEAN BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3341
Practice Address - Country:US
Practice Address - Phone:772-220-8459
Practice Address - Fax:772-600-1744
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1482231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist