Healthcare Provider Details

I. General information

NPI: 1083347165
Provider Name (Legal Business Name): NUTTHAGRITA VIVIAN ELLER MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VIVIAN ELLER MS, CCC-SLP

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date: 10/27/2025
Reactivation Date: 12/09/2025

III. Provider practice location address

2066 N CAPITOL AVE # 9025
SAN JOSE CA
95132-1015
US

IV. Provider business mailing address

2066 N CAPITOL AVE # 9025
SAN JOSE CA
95132-1015
US

V. Phone/Fax

Practice location:
  • Phone: 415-857-5783
  • Fax:
Mailing address:
  • Phone: 415-857-5783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number40552
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: