Healthcare Provider Details

I. General information

NPI: 1497498505
Provider Name (Legal Business Name): ELLEN CECELIA DENDINGER NONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2022
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 N MOUNTAIN AVE STE 109A
UPLAND CA
91786-5715
US

IV. Provider business mailing address

222 N MOUNTAIN AVE STE 109A
UPLAND CA
91786-5715
US

V. Phone/Fax

Practice location:
  • Phone: 909-610-9151
  • Fax:
Mailing address:
  • Phone: 909-610-9151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number39680
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: