Provider Demographics
NPI:1457885006
Name:DEHNERT, ELLEN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:ELLEN
Middle Name:
Last Name:DEHNERT
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 1:3845 E GREENWAY RD UNIT 118
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4676
Mailing Address - Country:US
Mailing Address - Phone:928-301-1936
Mailing Address - Fax:
Practice Address - Street 1:3845 E GREENWAY RD UNIT 118
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4676
Practice Address - Country:US
Practice Address - Phone:928-301-1936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP10267235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist