Individual
NICOLE ELLINGSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
15 S SIXTH ST, BAY SPRINGS, MS 39422-9052
(601) 764-2101
Mailing address
1912 MAMIE ST, HATTIESBURG, MS 39401-7434
(812) 241-5622
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S3891
MS
Other
Enumeration date
08/18/2014
Last updated
08/18/2014
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