Provider Demographics
NPI:1518617786
Name:WRIGHT, ELISHA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELISHA
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6156 W QUAIL RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:RATHDRUM
Mailing Address - State:ID
Mailing Address - Zip Code:83858-8343
Mailing Address - Country:US
Mailing Address - Phone:253-961-6394
Mailing Address - Fax:
Practice Address - Street 1:8052 W MAIN ST UNIT 107
Practice Address - Street 2:
Practice Address - City:RATHDRUM
Practice Address - State:ID
Practice Address - Zip Code:83858-4915
Practice Address - Country:US
Practice Address - Phone:208-712-6808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist