Provider Demographics
NPI:1942530241
Name:PONDER, ELAINE MARIE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:MARIE
Last Name:PONDER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 HEADWAY CR
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-5160
Mailing Address - Country:US
Mailing Address - Phone:512-615-6896
Mailing Address - Fax:
Practice Address - Street 1:611 HEADWAY CR
Practice Address - Street 2:BUILDING 2
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-5160
Practice Address - Country:US
Practice Address - Phone:512-615-6896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2010-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105577235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist