Healthcare Provider Details

I. General information

NPI: 1699063735
Provider Name (Legal Business Name): ELISA CAROLINA DELAROSA MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 07/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 E 23RD ST SUITE 200
FREMONT NE
68025-0800
US

IV. Provider business mailing address

225 SHIRLEY RAYE DR
DEL RIO TX
78840-0486
US

V. Phone/Fax

Practice location:
  • Phone: 866-784-2329
  • Fax:
Mailing address:
  • Phone: 830-734-3381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number104052
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: