Basic Information
| Provider Information | |||||||||
| NPI: | 1003162124 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | ELLEN | ||||||||
| MiddleName: | LIVERMAN | ||||||||
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| Credential: | MSP, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2211 HILLSBOROUGH RD APT 2090 | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277054168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034639543 | ||||||||
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| Practice Location | |||||||||
| Address1: | 155 BAKER HOUSE TRENT DR | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277100001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196846271 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2012 | ||||||||
| LastUpdateDate: | 07/26/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 10100 | NC | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 4950 | SC | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.