MEDICARE: KRISTA ELLIS SPEECH THERAPIST

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	SL007534	PA

General Provider Information

NPI Number	:	1366673071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA ELLIS SPEECH THERAPIST

Provider Business Mailing Address
First Line	:	520 PHILADELPHIA ST
Second Line	:
City	:	INDIANA
State	:	PA
Zip	:	15701-3902
Country	:	US
Telephone Number	:	724-463-7478
Fax Number	:	724-463-0931

Provider Business Practice Location Address
First Line	:	21 S PINE ST
Second Line	:
City	:	ELVERSON
State	:	PA
Zip	:	19520-9720
Country	:	US
Telephone Number	:	610-286-0977
Fax Number	:	610-286-0986

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

Provider Enumeration Date	:	07/29/2009
Last Update Date	:	07/29/2009

Similar Medicare Providers

1437156387 — GORDON RICHARD ECK D.O.
Practice Location Address:

11 S PINE ST
ELVERSON, PA
19520-9720

Practice Phone: 610-286-9000
Practice Fax: 610-286-9410

1376590711 — ST. JOSEPH REGIONAL HEALTH NETWORK
Practice Location Address:

45 S PINE ST
ELVERSON, PA
19520-9720

Practice Phone: 610-913-1234
Practice Fax: 717-531-0690

1679679385 — DANIEL J. FICK M.P.T.
Practice Location Address:

21 S PINE ST , HERITAGE MEDICAL CENTER
ELVERSON, PA
19520-9720

Practice Phone: 610-286-0977
Practice Fax: 610-286-0986

1336221381 — MR. JOHN FRANCIS PERRY III M.D.
Practice Location Address:

25 S PINE ST
ELVERSON, PA
19520-9720

Practice Phone: 610-286-1660
Practice Fax: 610-286-1662

1326284845 — MARGARET JEANETTE GEBERT
Practice Location Address:

21 S PINE ST
ELVERSON, PA
19520-9720

Practice Phone: 610-286-0977
Practice Fax: 610-286-0986

1578993069 — MARIE HELEN VILBERT PT
Practice Location Address:

21 S PINE ST
ELVERSON, PA
19520-9720

Practice Phone: 610-286-0977
Practice Fax: 610-286-0986

Directions to “ KRISTA ELLIS SPEECH THERAPIST” Practice Location

Language	Start Address	Practice Location

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