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General NPI Number Information
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NPI Number | 1144508599
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Entity Type | Organization
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Legal Business Name | DR. ALICIA A. ELLIOTT SPEECH PATHOLOGY, INC.
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Dates
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Enumeration Date | 08/02/2011
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Last Update Date | 08/02/2011
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Provider Practice Location Address
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Address Line | 2506 FOOTHILL BLVD
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City | LA CRESCENTA
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State | CA
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Zip | 91214-3506
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Country | US
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Telephone | 818-236-3603
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Fax | 818-236-2106
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Provider Business Mailing Address
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Address Line | 2506 FOOTHILL BLVD
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City | LA CRESCENTA
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State | CA
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Zip | 91214-3506
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Country | US
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Telephone | 818-236-3603
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Fax | 818-236-2106
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Authorized Official
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Title or Position | DIRECTOR/SPEECH PATHOLOGIST
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Name | DR. ALICIA A. ELLIOTT
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Credential | ED.D
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Telephone | 818-236-3603
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 4207
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License Number State | CA
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