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NPI Code Detail

MEDICARE: MRS. ADA LISA ELLEGOOD MA, CCC-SLP

MEDICARE: MRS. ADA LISA ELLEGOOD MA, CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language PathologistSA7976FL

General Provider Information

NPI Number : 1851522213
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ADA LISA ELLEGOOD MA, CCC-SLP
Provider Business Mailing Address
First Line : 2625 BARNA AVE
Second Line :
City : TITUSVILLE
State : FL
Zip : 32780-3417
Country : US
Telephone Number : 407-844-6812
Fax Number :
Provider Business Practice Location Address
First Line : 2625 BARNA AVE
Second Line :
City : TITUSVILLE
State : FL
Zip : 32780-3417
Country : US
Telephone Number : 407-844-6812
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2009
Last Update Date : 04/10/2026

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