Basic Information
| Provider Information | |||||||||
| NPI: | 1609956408 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COHEN | ||||||||
| FirstName: | ELLEN | ||||||||
| MiddleName: | MARLA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 290370 | ||||||||
| Address2: | |||||||||
| City: | FT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333290370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542624346 | ||||||||
| FaxNumber: | 9542622269 | ||||||||
| Practice Location | |||||||||
| Address1: | 106 TANGLEWOOD HOLW | ||||||||
| Address2: | |||||||||
| City: | HAYESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 289049259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067455450 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 01/25/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SA11594 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.