Individual
ELLENE AGNES AMODIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CCC/SLP
Contact information
Practice address
2635 YACHT CLUB BLVD, FORT LAUDERDALE, FL 33304-4529
(954) 257-4864
Mailing address
2635 YACHT CLUB BLVD, FORT LAUDERDALE, FL 33304-4529
(954) 257-4864
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA 6853
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SA 6853
DEPARTMENT OF HEALTH
FL
Enumeration date
06/03/2016
Last updated
06/03/2016
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