Healthcare Provider Details

I. General information

NPI: 1215499447
Provider Name (Legal Business Name): ELLENBECKER AND BORSELLINO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 07/09/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1994 GALLATIN PIKE N STE 202
MADISON TN
37115-2024
US

IV. Provider business mailing address

1994 GALLATIN PIKE N STE 202
MADISON TN
37115-2024
US

V. Phone/Fax

Practice location:
  • Phone: 615-596-1830
  • Fax: 615-766-8277
Mailing address:
  • Phone: 615-596-1830
  • Fax: 615-766-8277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGIE DAWN ELLENBECKER
Title or Position: OWNER/PRESIDENT
Credential: MS, CCC-SLP
Phone: 615-596-1830