Ellen Dezellem

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

LL60535425 Issued in WA

Practice address

216 E 4TH St
Port Angeles, WA 98362-3200

Phone

(360) 565-1733

NPI assigned

Feb 20, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1424390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424390400000",
    "number": "1972995405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "443 CEDAR PARK DR",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983628428",
            "telephone_number": "509-449-0644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 E 4TH ST",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983623200",
            "telephone_number": "360-565-1733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEZELLEM",
        "first_name": "ELLEN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-02-20",
        "last_updated": "2015-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WA",
            "license": "LL60535425",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alisha N Detorres, ND
• Michael John Devoney, LAC.
• Donna Dewey-Osborne, LPN
• Patrick Dewitt, COTA
• Darcy Deyling, LMHC-A
• Jessica A Dibari, D.O.
• Amy Lee Dibello
• Dirk a. Gouge, D.O.
• Ianir Divinsky, MD
• Miklo Jashua Dixon, BHT,CNA

• Speech-Language Pathologist in Port Angeles, WA
• Providers in Port Angeles, WA by specialty
• Speech-Language Pathologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2015; 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.