Basic Information
| Provider Information | |||||||||
| NPI: | 1629257472 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEVENS | ||||||||
| FirstName: | ELLEN | ||||||||
| MiddleName: | RUTH | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | HAD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8800 SE SUNNYSIDE RD. | ||||||||
| Address2: | STE. 300-N | ||||||||
| City: | CLACKAMAS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970155738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036595115 | ||||||||
| FaxNumber: | 3034389026 | ||||||||
| Practice Location | |||||||||
| Address1: | 6821 W. 120TH AVE. | ||||||||
| Address2: | STE #2H | ||||||||
| City: | BROOMFIELD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800202355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034386633 | ||||||||
| FaxNumber: | 3034389026 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2007 | ||||||||
| LastUpdateDate: | 06/14/2012 | ||||||||
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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 | 237700000X | 129 | CO | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 237700000X | HAD-129 | CO | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.