Provider Demographics
NPI:1679659650
Name:CARLISLE, YELENA ZOYA (MS CCC-SLP, CLC)
Entity Type:Individual
Prefix:MRS
First Name:YELENA
Middle Name:ZOYA
Last Name:CARLISLE
Suffix:
Gender:F
Credentials:MS CCC-SLP, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4811 VILLAGE SQ NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-3464
Mailing Address - Country:US
Mailing Address - Phone:404-665-7804
Mailing Address - Fax:
Practice Address - Street 1:4811 VILLAGE SQ NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30102-3464
Practice Address - Country:US
Practice Address - Phone:404-665-7804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
GASLP006410235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA850584527AMedicaid
GA85058427AMedicaid