Provider Demographics
NPI:1295068252
Name:LA FERNEY, ELLEN W (MS,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:W
Last Name:LA FERNEY
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 1:1738 N BARRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-3058
Mailing Address - Country:US
Mailing Address - Phone:479-871-0637
Mailing Address - Fax:
Practice Address - Street 1:1738 N BARRINGTON DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-3058
Practice Address - Country:US
Practice Address - Phone:479-871-0637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#866235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist