MEDICARE: DR. ELLEN FOSTER MATTINGLY SLP.D., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SA6347	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144464207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLEN FOSTER MATTINGLY SLP.D., CCC-SLP

Provider Business Mailing Address
First Line	:	2168 S JOG RD
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33415-6093
Country	:	US
Telephone Number	:	561-641-5757
Fax Number	:	561-641-7373

Provider Business Practice Location Address
First Line	:	2168 JOG ROAD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415
Country	:	US
Telephone Number	:	561-641-5757
Fax Number	:	561-641-7373

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2009
Last Update Date	:	12/13/2023

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Directions to “ DR. ELLEN FOSTER MATTINGLY SLP.D., CCC-SLP” Practice Location

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