Healthcare Provider Details

I. General information

NPI: 1336573229
Provider Name (Legal Business Name): ELLEN PATRICIA GREEN SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 08/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 WESTWIND DR BUILDING 500
BAKERSFIELD CA
93301-3055
US

IV. Provider business mailing address

8302 ESPRESSO DR 100
BAKERSFIELD CA
93312-5687
US

V. Phone/Fax

Practice location:
  • Phone: 661-377-1700
  • Fax: 661-616-9199
Mailing address:
  • Phone: 661-377-1700
  • Fax: 661-616-9199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberRPE 8153
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: