Healthcare Provider Details

I. General information

NPI: 1730327404
Provider Name (Legal Business Name): ELISHA'S SPEECH AND LANGUAGE SERVICES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2009
Last Update Date: 02/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 W SECOND ST APT 141
LONG BEACH MS
39560-5553
US

IV. Provider business mailing address

2012 W SECOND ST APT 141
LONG BEACH MS
39560-5553
US

V. Phone/Fax

Practice location:
  • Phone: 601-248-6841
  • Fax:
Mailing address:
  • Phone: 601-248-6841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. ELISHA ROKIA HARRELL
Title or Position: SPEECH LANGUAGE PATHOLOGIST/OWNER
Credential: M.S.CCC-SLP
Phone: 601-248-6841