Provider Demographics
NPI:1992179550
Name:ELLISH, LAUREN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:ELLISH
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 1:2233 W CALLE MARITA
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-7061
Mailing Address - Country:US
Mailing Address - Phone:480-444-9345
Mailing Address - Fax:
Practice Address - Street 1:2233 W CALLE MARITA
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-7061
Practice Address - Country:US
Practice Address - Phone:480-444-9345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-19
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist