Healthcare Provider Details

I. General information

NPI: 1659765113
Provider Name (Legal Business Name): SHAWNA ELLINGEN M.S.,CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SIMONSON BLVD
DEERFIELD WI
53531-9543
US

IV. Provider business mailing address

300 SIMONSON BLVD
DEERFIELD WI
53531-9543
US

V. Phone/Fax

Practice location:
  • Phone: 608-764-5431
  • Fax:
Mailing address:
  • Phone: 608-764-5431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number154-3755
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: