Provider Demographics
NPI:1306202908
Name:SAELI, ELENA
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:SAELI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 W RAILROAD AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-3855
Mailing Address - Country:US
Mailing Address - Phone:360-551-5092
Mailing Address - Fax:
Practice Address - Street 1:110 E SPENCER LAKE RD
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-7307
Practice Address - Country:US
Practice Address - Phone:360-427-2737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-12
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 60615366235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1306202908Medicaid