Provider Demographics
NPI:1750782835
Name:FYE, ELLEN CHRISTINE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:CHRISTINE
Last Name:FYE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 LESLIE AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22301-1616
Mailing Address - Country:US
Mailing Address - Phone:703-548-6912
Mailing Address - Fax:
Practice Address - Street 1:1321 LESLIE AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22301-1616
Practice Address - Country:US
Practice Address - Phone:703-548-6912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007109235Z00000X
MD02732235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist