Healthcare Provider Details

I. General information

NPI: 1992130330
Provider Name (Legal Business Name): JACQUELINE ELZIE SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 COLISEUM ST
LOS ANGELES CA
90016-5308
US

IV. Provider business mailing address

5100 COLISEUM ST
LOS ANGELES CA
90016-5308
US

V. Phone/Fax

Practice location:
  • Phone: 323-484-1734
  • Fax:
Mailing address:
  • Phone: 323-484-1734
  • Fax: 323-484-1734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA 2238
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: