Basic Information
| Provider Information | |||||||||
| NPI: | 1538435243 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WINEMAN | ||||||||
| FirstName: | ELLEN | ||||||||
| MiddleName: | FREY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 608 CRUM CREEK RD | ||||||||
| Address2: | |||||||||
| City: | MEDIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190631646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105254000 | ||||||||
| FaxNumber: | 6105266742 | ||||||||
| Practice Location | |||||||||
| Address1: | 551 W LANCASTER AVE | ||||||||
| Address2: | |||||||||
| City: | HAVERFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190411419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105254000 | ||||||||
| FaxNumber: | 6105266742 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2012 | ||||||||
| LastUpdateDate: | 03/27/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SL002395L | PA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.