Provider Demographics
NPI:1508550948
Name:ELIA, ELYSSA PAIGE (MS CF-SLP)
Entity Type:Individual
Prefix:
First Name:ELYSSA
Middle Name:PAIGE
Last Name:ELIA
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 PEARL ST APT 1004
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-2751
Mailing Address - Country:US
Mailing Address - Phone:936-205-8585
Mailing Address - Fax:
Practice Address - Street 1:3211 PEARL ST APT 1004
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-2751
Practice Address - Country:US
Practice Address - Phone:936-205-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120959235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist