Provider Demographics
NPI:1568859890
Name:ELSYNERGY INCORPORATED
Entity Type:Organization
Organization Name:ELSYNERGY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:LUKKONEN
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MM MA CCC-SLP
Authorized Official - Phone:678-825-6411
Mailing Address - Street 1:247 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-5705
Mailing Address - Country:US
Mailing Address - Phone:678-825-6411
Mailing Address - Fax:678-796-7611
Practice Address - Street 1:247 JACKSON ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-5705
Practice Address - Country:US
Practice Address - Phone:678-825-6411
Practice Address - Fax:678-796-7611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007119261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech