MEDICARE: ELISSIA LOTTIHALL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	9131	SC

General Provider Information

NPI Number	:	1497556542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISSIA LOTTIHALL

Provider Business Mailing Address
First Line	:	1 HARBISON WAY STE 101
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212-3408
Country	:	US
Telephone Number	:	803-386-1880
Fax Number	:	803-888-4715

Provider Business Practice Location Address
First Line	:	1 HARBISON WAY STE 101
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212-3408
Country	:	US
Telephone Number	:	803-386-1880
Fax Number	:	803-888-4715

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2025
Last Update Date	:	03/24/2025

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Directions to “ ELISSIA LOTTIHALL ” Practice Location

Language	Start Address	Practice Location

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