Provider Demographics
NPI:1457721029
Name:HAUGH, ELISE (SLP)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:HAUGH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8635 SANDSTONE CT
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-9517
Mailing Address - Country:US
Mailing Address - Phone:916-806-1883
Mailing Address - Fax:916-740-4629
Practice Address - Street 1:8635 SANDSTONE CT
Practice Address - Street 2:
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-9517
Practice Address - Country:US
Practice Address - Phone:916-806-1883
Practice Address - Fax:916-740-4629
Is Sole Proprietor?:No
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP987235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP987OtherLICENSE