Provider Demographics
NPI:1831420405
Name:SCHWARTZ, ELLEN R (MA)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:R
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 SAINT JAMES PL
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3936
Mailing Address - Country:US
Mailing Address - Phone:215-923-3886
Mailing Address - Fax:
Practice Address - Street 1:295 SAINT JAMES PL
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3936
Practice Address - Country:US
Practice Address - Phone:215-923-3886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL-000104-L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist