Provider Demographics
NPI:1487285748
Name:FRITZ, ELLEN MARY (SLP)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARY
Last Name:FRITZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:MARY
Other - Last Name:SHIMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1035 HERITAGE LN
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-9342
Mailing Address - Country:US
Mailing Address - Phone:612-877-2349
Mailing Address - Fax:
Practice Address - Street 1:1035 HERITAGE LN
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-9342
Practice Address - Country:US
Practice Address - Phone:612-877-2349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty