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NPI Code Detail

MEDICARE: LIANA K ELLER MS, CCC-SLP

MEDICARE: LIANA K ELLER MS, 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
1235Z00000XSpeech-Language Pathologist4409CT

General Provider Information

NPI Number : 1902166143
Entity Type Code : Individual
Provider Name (Legal Business Name) : LIANA K ELLER MS, CCC-SLP
Provider Business Mailing Address
First Line : 1715 ELLINGTON RD
Second Line :
City : SOUTH WINDSOR
State : CT
Zip : 06074-2707
Country : US
Telephone Number : 869-432-9555
Fax Number : 860-432-9556
Provider Business Practice Location Address
First Line : 1715 ELLINGTON RD
Second Line :
City : SOUTH WINDSOR
State : CT
Zip : 06074-2707
Country : US
Telephone Number : 860-432-9555
Fax Number : 860-432-9556
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2012
Last Update Date : 03/21/2014

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