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General NPI Number Information
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NPI Number | 1275288581
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Entity Type | Individual
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Provider Name | ANGELINE ELLIOTT MS, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 02/15/2022
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Last Update Date | 02/15/2022
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Provider Practice Location Address
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Address Line | 501 VES RD
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City | LYNCHBURG
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State | VA
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Zip | 24503-4638
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Country | US
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Telephone | 434-386-3305
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Fax |
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Provider Business Mailing Address
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Address Line | 1356 W CROSSING DR
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City | FOREST
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State | VA
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Zip | 24551-4940
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Country | US
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Telephone | 704-651-4639
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2202009064
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License Number State | VA
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