Provider Demographics
NPI:1386043255
Name:ELMORE, NEENA LYN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NEENA
Middle Name:LYN
Last Name:ELMORE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5817 HWY 412 S
Mailing Address - Street 2:
Mailing Address - City:BELLS
Mailing Address - State:TN
Mailing Address - Zip Code:38006-3974
Mailing Address - Country:US
Mailing Address - Phone:731-697-0586
Mailing Address - Fax:
Practice Address - Street 1:5817 HWY 412 S
Practice Address - Street 2:
Practice Address - City:BELLS
Practice Address - State:TN
Practice Address - Zip Code:38006-3974
Practice Address - Country:US
Practice Address - Phone:731-697-0586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-17
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5470235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist