Provider Demographics
NPI:1508110156
Name:LEE-ELMORE, CONNIE CORDELIA (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:CORDELIA
Last Name:LEE-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 1:8552 S 160TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-1335
Mailing Address - Country:US
Mailing Address - Phone:402-319-0900
Mailing Address - Fax:
Practice Address - Street 1:8552 S 160TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68136-1335
Practice Address - Country:US
Practice Address - Phone:402-319-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1095235Z00000X
MO2002022539235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist