Healthcare Provider Details

I. General information

NPI: 1508954538
Provider Name (Legal Business Name): HEATHER ANNETTE ELZA MSCCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 W HIGHWAY 30
EAST BERNSTADT KY
40729-6106
US

IV. Provider business mailing address

536 W HIGHWAY 30
EAST BERNSTADT KY
40729-6106
US

V. Phone/Fax

Practice location:
  • Phone: 606-843-6781
  • Fax: 606-862-0033
Mailing address:
  • Phone: 606-843-6781
  • Fax: 606-862-0033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberKY-2797
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: