1275288581 NPI number — MRS. ANGELINE ELLIOTT MS, CCC-SLP

Table of content: MRS. ANGELINE ELLIOTT MS, CCC-SLP (NPI 1275288581)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275288581 NPI number — MRS. ANGELINE ELLIOTT MS, CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELLIOTT
Provider First Name:
ANGELINE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275288581
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1356 W CROSSING DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOREST
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24551-4940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-651-4639
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 VES RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNCHBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24503-4638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-386-3305
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/15/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  2202009064 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)