Active NPI
Colette Leonie Ellis, M.ED.,CCC-SLP
- Speech-Language Pathologist
- Chickasha, OK
National Provider Identifier
1043364458
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 327
- Practice address
- 1211 S 29TH St
Chickasha, OK 73018-9651 - Phone
- (405) 224-0002
- Fax
- (405) 224-0133
- NPI assigned
- Jan 22, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 327 | OK | Primary |
Addresses
Primary practice location
1211 S 29TH St
Chickasha, OK 73018-9651
Mailing address
415 Fieldcrest Dr
Chickasha, OK 73018-7755
Phone (405) 921-2979
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 327 | OK | MD | Audiologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1043364458",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "415 FIELDCREST DR",
"city": "CHICKASHA",
"state": "OK",
"postal_code": "730187755",
"telephone_number": "405-921-2979"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1211 S 29TH ST",
"city": "CHICKASHA",
"state": "OK",
"postal_code": "730189651",
"telephone_number": "405-224-0002",
"fax_number": "405-224-0133"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "COLETTE",
"middle_name": "LEONIE",
"name_prefix": "Mrs.",
"credential": "M.ED.,CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "OK",
"license": "327",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chickasha, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.