Provider Demographics
NPI:1679321301
Name:WILLETT, ELLEN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:WILLETT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:REITSEMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:20500 E ARAPAHOE RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-1798
Mailing Address - Country:US
Mailing Address - Phone:720-886-6609
Mailing Address - Fax:
Practice Address - Street 1:20500 E ARAPAHOE RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-1798
Practice Address - Country:US
Practice Address - Phone:720-886-6609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO332005235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist