Provider Demographics
NPI:1801550603
Name:MEYER, ELLEN J (MT-BC, NMT, CBIS)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:J
Last Name:MEYER
Suffix:
Gender:F
Credentials:MT-BC, NMT, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 S 64TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53219-2644
Mailing Address - Country:US
Mailing Address - Phone:414-881-6671
Mailing Address - Fax:
Practice Address - Street 1:1820 S 75TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-5709
Practice Address - Country:US
Practice Address - Phone:262-204-5285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
11160225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist