Provider Demographics
NPI:1497221519
Name:ELLIOTT, KAMRYN LEE (SLP)
Entity Type:Individual
Prefix:
First Name:KAMRYN
Middle Name:LEE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KAMYRN
Other - Middle Name:
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:1905 LEARY LN
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901
Mailing Address - Country:US
Mailing Address - Phone:361-573-0731
Mailing Address - Fax:361-573-1594
Practice Address - Street 1:2907 MIORI LN
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901
Practice Address - Country:US
Practice Address - Phone:361-573-0731
Practice Address - Fax:361-573-1594
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113923235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113923OtherSPEECH LANGUAGE PATHOLOGIST