Provider Demographics
NPI:1417236936
Name:SPEECH WORKS BY ELISSA, LLC
Entity Type:Organization
Organization Name:SPEECH WORKS BY ELISSA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELISSA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP MS SPED
Authorized Official - Phone:702-733-8255
Mailing Address - Street 1:2557 BLACK RIVER FALLS DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89044-1010
Mailing Address - Country:US
Mailing Address - Phone:702-516-1300
Mailing Address - Fax:702-947-2294
Practice Address - Street 1:331 N BUFFALO DR
Practice Address - Street 2:STUITE B
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-0300
Practice Address - Country:US
Practice Address - Phone:702-733-8255
Practice Address - Fax:702-737-8255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP940235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty