Individual
MRS. COLETTE LEONIE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED.,CCC-SLP
Contact information
Practice address
1211 S 29TH ST, CHICKASHA, OK 73018-9651
(405) 224-0002
(405) 224-0133
Mailing address
415 FIELDCREST DR, CHICKASHA, OK 73018-7755
(405) 921-2979
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
327
OK
Other
Enumeration date
01/22/2007
Last updated
07/08/2007
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