Individual
ELLEN LIVERSIDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
HWY 64, OLD HIGH SCHOOL RD., SHIPROCK, NM 87420
(505) 368-4984
Mailing address
4923 DEL MONTE AVE, SAN DIEGO, CA 92107-3208
(301) 775-3649
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5271
NM
Other
Enumeration date
03/21/2017
Last updated
03/21/2017
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