Nikki Leigh Ellis, M.S. CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA13813 Issued in FL

Practice address

4624 Summerdale Dr
Pace, FL 32571-1368

Phone

(850) 994-3456

Fax

(850) 994-3476

NPI assigned

May 20, 2014

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Nikki Leigh Justice Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kids Talk Place LLC

  • Clinic/Center
  • Crestview, FL
  • NPI 1932861234
  NPD
• Kids Talk Place LLC

  • Clinic/Center
  • Pace, FL
  • NPI 1679590632
  NPD (past)
• Triple E OT Inc

  • Pediatric Occupational Therapist
  • Crestview, FL
  • NPI 1710271374
  NPD (past)
• Triple E OT, Inc

  • Occupational Therapist
  • Defuniak Springs, FL
  • NPI 1720395759
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1400544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699488000000",
    "number": "1821409228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3107 SUSAN DR",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325399019",
            "telephone_number": "440-781-1057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4624 SUMMERDALE DR",
            "city": "PACE",
            "state": "FL",
            "postal_code": "325711368",
            "telephone_number": "850-994-3456",
            "fax_number": "850-994-3476"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3107 Susan Dr",
            "address_purpose": "LOCATION",
            "city": "Crestview",
            "state": "FL",
            "postal_code": "325399019",
            "country_code": "US",
            "telephone_number": "440-781-1057",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "NIKKI",
        "middle_name": "LEIGH",
        "name_prefix": "Mrs.",
        "credential": "M.S. CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-05-20",
        "last_updated": "2023-11-09",
        "certification_date": "2023-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "FL",
            "license": "SA13813",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA13813",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NIKKI",
            "last_name": "JUSTICE",
            "middle_name": "LEIGH",
            "credential": "M.S. CCC-SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Debora Fra Edwards
• Julisa Edwards, MSW, CBHCM
• Kaci Edwards
• Mark Edwards, MD
• Amy Carol Ellis, L.M.H.C.
• Emerald Coast Pediatrics, P.a.
• David Ertle
• Escambia Community Clinics Inc
• Eternal Sole Foot and Ankle LLC
• April M Evans, APRN

• Speech-Language Pathologist in Pace, FL
• Providers in Pace, FL by specialty
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.