Provider Demographics
NPI:1578949558
Name:BOLTON, ELSIE (MA, CF-SLP)
Entity Type:Individual
Prefix:
First Name:ELSIE
Middle Name:
Last Name:BOLTON
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1979 LAKESIDE PKWY
Mailing Address - Street 2:SUITE 800
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-5935
Mailing Address - Country:US
Mailing Address - Phone:901-409-4642
Mailing Address - Fax:
Practice Address - Street 1:1979 LAKESIDE PKWY
Practice Address - Street 2:SUITE 800
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5935
Practice Address - Country:US
Practice Address - Phone:901-409-4642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist