Therersa Wolf Ellis-Elgart

Key facts

NPI

1962057323

Entity type

Individual (NPI type 1)

Primary specialty

Speech-Language Pathologist 235Z00000X

License

SP-872 (HI)

Practice address

475 22ND Ave RM 127
Honolulu, HI 96816-4400

Phone

(808) 305-9750

NPI assigned

Aug 2, 2019

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 2, 2019.

{
    "created_epoch": "1564704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564704000000",
    "number": "1962057323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 22ND AVE RM 127",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968164400",
            "telephone_number": "808-305-9750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 22ND AVE RM 127",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968164400",
            "telephone_number": "808-305-9750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS-ELGART",
        "first_name": "THERERSA",
        "middle_name": "WOLF",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-02",
        "last_updated": "2019-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "HI",
            "license": "SP-872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Honolulu, HI · Speech-Language Pathologist in Hawaii