Individual
MS. ANGIE DAWN ELLENBECKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
1994 GALLATIN PIKE N STE 309, MADISON, TN 37115-2025
(615) 596-1830
(615) 766-8277
Mailing address
513 SALT LICK TRL, GOODLETTSVILLE, TN 37072-3321
(615) 596-1830
(615) 766-8277
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
1179
NV
235Z00000X
Speech-Language Pathologist
Primary
ST5779
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457518417
—
NV
Enumeration date
05/19/2008
Last updated
04/12/2019
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