Healthcare Provider Details

I. General information

NPI: 1497482376
Provider Name (Legal Business Name): SARAH ELLIS MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 OLD PECOS TRL STE 1
SANTA FE NM
87505-4759
US

IV. Provider business mailing address

523 MADISON PL SE
ALBUQUERQUE NM
87108-3473
US

V. Phone/Fax

Practice location:
  • Phone: 505-424-8777
  • Fax:
Mailing address:
  • Phone:
  • 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: