Active NPI
Ellen Chifici Van Wagener, MCD, CCC-SLP
- Speech-Language Pathologist
- Prairieville, LA
National Provider Identifier
1821387804
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 4776
- Practice address
- 36515 Manchac Trace Ave
Prairieville, LA 70769-3223 - Phone
- (225) 333-0685
- NPI assigned
- Mar 30, 2011
- Sex
- Female
- Sole proprietor
- No
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 | 4776 | LA | Primary |
Addresses
Primary practice location
36515 Manchac Trace Ave
Prairieville, LA 70769-3223
Mailing address
36515 Manchac Trace Ave
Prairieville, LA 70769-3223
Phone (225) 333-0685
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4776 | LA | MD | Counselor |
| 108505 | TX | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1301443200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1301443200000",
"number": "1821387804",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "36515 MANCHAC TRACE AVE",
"city": "PRAIRIEVILLE",
"state": "LA",
"postal_code": "707693223",
"telephone_number": "225-333-0685"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "36515 MANCHAC TRACE AVE",
"city": "PRAIRIEVILLE",
"state": "LA",
"postal_code": "707693223",
"telephone_number": "225-333-0685"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN WAGENER",
"first_name": "ELLEN",
"middle_name": "CHIFICI",
"name_prefix": "Mrs.",
"credential": "MCD, CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-03-30",
"last_updated": "2011-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "LA",
"license": "4776",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Prairieville, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.