Provider Demographics
NPI:1003447806
Name:MASON, CLARISSA-ELAINE ELIZEBETH (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CLARISSA-ELAINE
Middle Name:ELIZEBETH
Last Name:MASON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1152 LAUREL FORK RD
Mailing Address - Street 2:
Mailing Address - City:DUCK
Mailing Address - State:WV
Mailing Address - Zip Code:25063-9150
Mailing Address - Country:US
Mailing Address - Phone:304-880-6512
Mailing Address - Fax:
Practice Address - Street 1:98 CARTER BRAXTON DR
Practice Address - Street 2:
Practice Address - City:SUTTON
Practice Address - State:WV
Practice Address - Zip Code:26601-9592
Practice Address - Country:US
Practice Address - Phone:304-765-7101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-2050235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist