Provider Demographics
NPI:1891039806
Name:ELLIOTT, RAMONA MCRAE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:RAMONA
Middle Name:MCRAE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8720 RANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-4462
Mailing Address - Country:US
Mailing Address - Phone:501-960-8677
Mailing Address - Fax:
Practice Address - Street 1:6323 COLONEL GLENN RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-7733
Practice Address - Country:US
Practice Address - Phone:501-569-9092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR12087/22235Z00000X
ARSP#3207235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR194045721Medicaid