Healthcare Provider Details

I. General information

NPI: 1902736333
Provider Name (Legal Business Name): KIMBERLY GRASSO ELSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 DOUCET RD STE 104A
LAFAYETTE LA
70503-3407
US

IV. Provider business mailing address

109 MILLING WAY
YOUNGSVILLE LA
70592-6923
US

V. Phone/Fax

Practice location:
  • Phone: 337-595-0063
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number8679
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: