Provider Demographics
NPI:1245505494
Name:TARUMOTO, ELSIE KIMIKO (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:ELSIE
Middle Name:KIMIKO
Last Name:TARUMOTO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:ELSIE
Other - Middle Name:KIMIKO
Other - Last Name:TARUMOTO-KURASHIMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:860 FOURTH ST
Mailing Address - Street 2:ROOM 150
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-3312
Mailing Address - Country:US
Mailing Address - Phone:808-453-6960
Mailing Address - Fax:808-453-6964
Practice Address - Street 1:860 FOURTH ST
Practice Address - Street 2:ROOM 150
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-3312
Practice Address - Country:US
Practice Address - Phone:808-453-6969
Practice Address - Fax:808-453-6964
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HISP-149235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI044164OtherHPMMIS MEDICAID PROVIDER ID