Provider Demographics
NPI:1598036568
Name:NORRIS-ROSE, ELISSA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:
Last Name:NORRIS-ROSE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:ELISSA
Other - Middle Name:
Other - Last Name:NORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:PO BOX 5029
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37802-5029
Mailing Address - Country:US
Mailing Address - Phone:865-982-3400
Mailing Address - Fax:865-982-3410
Practice Address - Street 1:2030 CHILHOWEE MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5285
Practice Address - Country:US
Practice Address - Phone:865-982-3400
Practice Address - Fax:865-982-3410
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4696235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12081558OtherASHA