Provider Demographics
NPI:1497556542
Name:LOTTIHALL, ELISSIA
Entity type:Individual
Prefix:
First Name:ELISSIA
Middle Name:
Last Name:LOTTIHALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HARBISON WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-3408
Mailing Address - Country:US
Mailing Address - Phone:803-386-1880
Mailing Address - Fax:803-888-4715
Practice Address - Street 1:1 HARBISON WAY STE 101
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-3408
Practice Address - Country:US
Practice Address - Phone:803-386-1880
Practice Address - Fax:803-888-4715
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9131235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist