Provider Demographics
NPI:1134898414
Name:HURLBERT, ELLIE MARIE (SLP)
Entity type:Individual
Prefix:
First Name:ELLIE
Middle Name:MARIE
Last Name:HURLBERT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ELLIE
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:1495 NW GILMAN BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5328
Mailing Address - Country:US
Mailing Address - Phone:425-392-2346
Mailing Address - Fax:
Practice Address - Street 1:1495 NW GILMAN BLVD STE 4
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5328
Practice Address - Country:US
Practice Address - Phone:425-392-2346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist