Healthcare Provider Details

I. General information

NPI: 1255665733
Provider Name (Legal Business Name): MICHELLE D. ELLIS M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 09/21/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 E PANHANDLE ST
SLATON TX
79364-4238
US

IV. Provider business mailing address

140 E PANHANDLE ST
SLATON TX
79364-4238
US

V. Phone/Fax

Practice location:
  • Phone: 806-828-6591
  • Fax:
Mailing address:
  • Phone: 575-403-8844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number117955
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: