Provider Demographics
NPI:1346230570
Name:ELAM, DAVID S (MA CCC SLP)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:S
Last Name:ELAM
Suffix:
Gender:M
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1133 N H ST
Mailing Address - Street 2:I
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-3368
Mailing Address - Country:US
Mailing Address - Phone:805-733-4542
Mailing Address - Fax:805-733-4392
Practice Address - Street 1:1133 N H ST
Practice Address - Street 2:I
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-3368
Practice Address - Country:US
Practice Address - Phone:805-733-4542
Practice Address - Fax:805-733-4392
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP5420235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0663623OtherCHAMPUS
CAGSP000390Medicaid
CA056582Medicare ID - Type Unspecified