Provider Demographics
NPI:1932310141
Name:MUSIAK, ELLEN LARSON (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:LARSON
Last Name:MUSIAK
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 LARKSPUR CT
Mailing Address - Street 2:
Mailing Address - City:PINGREE GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60140-9147
Mailing Address - Country:US
Mailing Address - Phone:269-207-8395
Mailing Address - Fax:847-699-5037
Practice Address - Street 1:241 GOLF MILL CTR
Practice Address - Street 2:SUITE 201-203
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-1224
Practice Address - Country:US
Practice Address - Phone:847-699-9757
Practice Address - Fax:847-699-5037
Is Sole Proprietor?:No
Enumeration Date:2007-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist