Individual
ELLIE CAROLINE MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFY-SLP
Contact information
Practice address
551 KOKOPELLI BLVD UNIT E, FRUITA, CO 81521
(970) 858-2526
(970) 858-8244
Mailing address
PO BOX 130, FRUITA, CO 81521-0130
(970) 858-3900
(970) 858-2208
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP.0003431
CO
Other
Enumeration date
06/19/2013
Last updated
10/28/2019
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