Healthcare Provider Details

I. General information

NPI: 1184941239
Provider Name (Legal Business Name): TASHA RENEE ELBERT-MCCLAIN M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7444 PICARDY AVE STE B
BATON ROUGE LA
70808-4331
US

IV. Provider business mailing address

PO BOX 73046
BATON ROUGE LA
70874
US

V. Phone/Fax

Practice location:
  • Phone: 225-216-7885
  • Fax:
Mailing address:
  • Phone: 225-328-7258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLA8314
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number6206
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: