Healthcare Provider Details

I. General information

NPI: 1114802352
Provider Name (Legal Business Name): ELLORY ANNE FARMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2025
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1738 THOMASVILLE RD
TALLAHASSEE FL
32303-5754
US

IV. Provider business mailing address

3134 S FULMER CIR
TALLAHASSEE FL
32303-1722
US

V. Phone/Fax

Practice location:
  • Phone: 850-909-5521
  • Fax:
Mailing address:
  • Phone: 231-740-9549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: