Provider Demographics
NPI:1174893515
Name:DERES, ELLEN JOAN (AUD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:JOAN
Last Name:DERES
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:JOAN
Other - Last Name:PEARCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 PILLSBURY ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3556
Mailing Address - Country:US
Mailing Address - Phone:603-856-8275
Mailing Address - Fax:
Practice Address - Street 1:1 PILLSBURY ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3556
Practice Address - Country:US
Practice Address - Phone:603-856-8275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-03
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9493231H00000X
NHA786231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist