Provider Demographics
NPI:1902228224
Name:DEARING, ELLYN (MS, CFY-SLP)
Entity Type:Individual
Prefix:MS
First Name:ELLYN
Middle Name:
Last Name:DEARING
Suffix:
Gender:F
Credentials:MS, CFY-SLP
Other - Prefix:MS
Other - First Name:ELLYN
Other - Middle Name:
Other - Last Name:ATKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CFY-SLP
Mailing Address - Street 1:106 PALM ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:IL
Mailing Address - Zip Code:61520-1131
Mailing Address - Country:US
Mailing Address - Phone:309-338-3445
Mailing Address - Fax:
Practice Address - Street 1:2018 W CIMARRON DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-3917
Practice Address - Country:US
Practice Address - Phone:309-693-4424
Practice Address - Fax:309-693-4426
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.002826235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist