Provider Demographics
NPI:1184941239
Name:ELBERT-MCCLAIN, TASHA RENEE (MS)
Entity type:Individual
Prefix:MRS
First Name:TASHA
Middle Name:RENEE
Last Name:ELBERT-MCCLAIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 73046
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70874
Mailing Address - Country:US
Mailing Address - Phone:225-328-7258
Mailing Address - Fax:
Practice Address - Street 1:7444 PICARDY AVE STE B
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4331
Practice Address - Country:US
Practice Address - Phone:225-216-7885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA62062355S0801X
LALA8314225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant