Provider Demographics
NPI:1487133393
Name:ELLARD, AMY CATHERINE (MS, SLP-CFY)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:CATHERINE
Last Name:ELLARD
Suffix:
Gender:F
Credentials:MS, SLP-CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5872 OLD JACKSONVILLE HWY APT 325
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0606
Mailing Address - Country:US
Mailing Address - Phone:601-597-7725
Mailing Address - Fax:
Practice Address - Street 1:1401 RICE RD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-3233
Practice Address - Country:US
Practice Address - Phone:903-561-6060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114714235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist