Provider Demographics
NPI:1184749301
Name:ELLSON, JILL L (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:L
Last Name:ELLSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3685 WIESTERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:EXPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15632-9361
Mailing Address - Country:US
Mailing Address - Phone:724-493-8189
Mailing Address - Fax:
Practice Address - Street 1:3685 WIESTERTOWN RD
Practice Address - Street 2:
Practice Address - City:EXPORT
Practice Address - State:PA
Practice Address - Zip Code:15632-9361
Practice Address - Country:US
Practice Address - Phone:724-493-8189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL000297L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist