Individual
MS. SHIRLEY ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLPD, CCC-SLP
Contact information
Practice address
220 N HARLEM ST, EUDORA, AR 71640-2755
(618) 306-0889
Mailing address
220 N HARLEM ST, EUDORA, AR 71640-2755
(618) 306-0889
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146.008667
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12096835
AMERICAN SPEECH-LANGUAGE AND HEARING ASSOCIATION
MD
Enumeration date
08/09/2012
Last updated
06/10/2020
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