Provider Demographics
NPI:1851605869
Name:ELLIS, JOHN B (MS CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:B
Last Name:ELLIS
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-7637
Mailing Address - Country:US
Mailing Address - Phone:434-466-8404
Mailing Address - Fax:
Practice Address - Street 1:1221 ROSSER AVE
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-3336
Practice Address - Country:US
Practice Address - Phone:540-949-7191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist