Provider Demographics
NPI:1487957304
Name:EMMONS, ELLEN M (AUD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:EMMONS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 E N B BAROODY ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2523
Mailing Address - Country:US
Mailing Address - Phone:843-662-7802
Mailing Address - Fax:843-662-5609
Practice Address - Street 1:153 E N B BAROODY ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2523
Practice Address - Country:US
Practice Address - Phone:843-662-7802
Practice Address - Fax:843-662-5609
Is Sole Proprietor?:No
Enumeration Date:2010-12-15
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3692231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6987236OtherCIGNA
NCP01377062OtherMEDICARE, RAILROAD
SCP01388645OtherRAILROAD MEDICARE
SC30121507OtherSELECT HEALTH OF SC
NC9790602OtherAETNA
SCQ427035874OtherMEDICARE
NC7413812Medicaid
SCSAN101Medicaid
SCP01388645OtherRAILROAD MEDICARE