Provider Demographics
NPI:1053750372
Name:ROUX, ELLEN A (CCC,SLP)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:A
Last Name:ROUX
Suffix:
Gender:F
Credentials:CCC,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 MOLLY PITCHER LN APT C
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-1530
Mailing Address - Country:US
Mailing Address - Phone:914-245-3292
Mailing Address - Fax:
Practice Address - Street 1:96 MOLLY PITCHER LN APT C
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-1530
Practice Address - Country:US
Practice Address - Phone:914-245-3292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004591-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist