Provider Demographics
NPI:1457789331
Name:ELLIS, KRISTIN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:ELLIS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:SCHNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:80 CALL MOUNTAIN CIR
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-6001
Mailing Address - Country:US
Mailing Address - Phone:484-629-5484
Mailing Address - Fax:484-601-2283
Practice Address - Street 1:80 CALL MOUNTAIN CIR
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-6001
Practice Address - Country:US
Practice Address - Phone:484-601-2283
Practice Address - Fax:484-601-2283
Is Sole Proprietor?:No
Enumeration Date:2013-10-31
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL011133235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist