Provider Demographics
NPI:1205972452
Name:THOMAS, ELLEN KISSEL
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:KISSEL
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ELLEN
Other - Middle Name:ELIZABETH
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:15625 ANTIETAM AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-3137
Mailing Address - Country:US
Mailing Address - Phone:225-753-3804
Mailing Address - Fax:
Practice Address - Street 1:1805 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-1919
Practice Address - Country:US
Practice Address - Phone:225-923-3420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA772046235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist