MEDICARE: MS. ELISHA ROKIA HARRELL M.S.CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	12096617	MS
2	235Z00000X	Speech-Language Pathologist	S3242	MS
3	235Z00000X	Speech-Language Pathologist	199291	MS

General Provider Information

NPI Number	:	1316185796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELISHA ROKIA HARRELL M.S.CCC-SLP

Provider Business Mailing Address
First Line	:	2012 W SECOND ST
Second Line	:	APT 141
City	:	LONG BEACH
State	:	MS
Zip	:	39560-5553
Country	:	US
Telephone Number	:	601-248-6841
Fax Number	:

Provider Business Practice Location Address
First Line	:	2012 W SECOND ST
Second Line	:	APT 141
City	:	LONG BEACH
State	:	MS
Zip	:	39560-5553
Country	:	US
Telephone Number	:	601-248-6841
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2009
Last Update Date	:	01/23/2009

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Directions to “ MS. ELISHA ROKIA HARRELL M.S.CCC-SLP” Practice Location

Language	Start Address	Practice Location

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