Provider Demographics
NPI:1053549469
Name:BREWER, ELLEN J
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:J
Last Name:BREWER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:JOYCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC -SP
Mailing Address - Street 1:58 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1809
Mailing Address - Country:US
Mailing Address - Phone:413-528-9246
Mailing Address - Fax:413-528-6283
Practice Address - Street 1:58 SOUTH ST
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1809
Practice Address - Country:US
Practice Address - Phone:413-528-9246
Practice Address - Fax:413-528-6283
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2527235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist