Provider Demographics
NPI:1316185796
Name:HARRELL, ELISHA ROKIA (MSCCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ELISHA
Middle Name:ROKIA
Last Name:HARRELL
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 W SECOND ST
Mailing Address - Street 2:APT 141
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560-5553
Mailing Address - Country:US
Mailing Address - Phone:601-248-6841
Mailing Address - Fax:
Practice Address - Street 1:2012 W SECOND ST
Practice Address - Street 2:APT 141
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560-5553
Practice Address - Country:US
Practice Address - Phone:601-248-6841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12096617235Z00000X
MSS3242235Z00000X
MS199291235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist