Provider Demographics
NPI:1407582588
Name:ELLIOTT, ALANNAH RAE (AS)
Entity Type:Individual
Prefix:
First Name:ALANNAH
Middle Name:RAE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:MI
Mailing Address - Zip Code:49345-1234
Mailing Address - Country:US
Mailing Address - Phone:616-818-8375
Mailing Address - Fax:
Practice Address - Street 1:88 SOUTH ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:MI
Practice Address - Zip Code:49345-1234
Practice Address - Country:US
Practice Address - Phone:616-818-8375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician