Provider Demographics
NPI:1922430933
Name:RIDENOUR, ELLEN K (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:K
Last Name:RIDENOUR
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 1:3401 FIREFLY CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-4717
Mailing Address - Country:US
Mailing Address - Phone:614-876-0204
Mailing Address - Fax:
Practice Address - Street 1:1818 1/2 BASIL WESTERN RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:OH
Practice Address - Zip Code:43105-9334
Practice Address - Country:US
Practice Address - Phone:614-600-2428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 2149235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SP 2149OtherBOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY