Provider Demographics
NPI:1811938483
Name:PEARSON, ELLEN J (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:J
Last Name:PEARSON
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 1:8905 COLCHESTER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-1410
Mailing Address - Country:US
Mailing Address - Phone:865-531-3097
Mailing Address - Fax:
Practice Address - Street 1:103 SUBURBAN RD
Practice Address - Street 2:SUITE 101 D
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-5586
Practice Address - Country:US
Practice Address - Phone:865-769-0283
Practice Address - Fax:865-769-0281
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00001278235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNSP00001278OtherLICENSE NUMBER