Provider Demographics
NPI:1265935852
Name:ELLEDGE, DEBORAH HARDING (PHD, CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:HARDING
Last Name:ELLEDGE
Suffix:
Gender:F
Credentials:PHD, 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:E4125 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-2408
Mailing Address - Country:US
Mailing Address - Phone:715-271-9740
Mailing Address - Fax:
Practice Address - Street 1:242 WATER ST
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-5699
Practice Address - Country:US
Practice Address - Phone:715-836-4869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3860-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist