Provider Demographics
NPI:1447640818
Name:ELLIS, FELINDA PAIGE (MA)
Entity type:Individual
Prefix:
First Name:FELINDA
Middle Name:PAIGE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 OAK HIDEAWAY DR
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:TX
Mailing Address - Zip Code:78133-5019
Mailing Address - Country:US
Mailing Address - Phone:210-410-3579
Mailing Address - Fax:210-495-2540
Practice Address - Street 1:225 E SONTERRA BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3992
Practice Address - Country:US
Practice Address - Phone:210-495-9944
Practice Address - Fax:210-495-2540
Is Sole Proprietor?:No
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14454235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist