Provider Demographics
NPI:1184110462
Name:BACKMAN, ELAINE (BC-HIS)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:
Last Name:BACKMAN
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3675 S RAINBOW BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-1059
Mailing Address - Country:US
Mailing Address - Phone:702-873-5063
Mailing Address - Fax:702-873-5065
Practice Address - Street 1:3675 S RAINBOW BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-1059
Practice Address - Country:US
Practice Address - Phone:702-873-5063
Practice Address - Fax:702-873-5065
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVHAS-0560237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist