Provider Demographics
NPI:1508042623
Name:ELLIOTT, ANNA JONES (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:JONES
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27730 SAN PORTOLA
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-1852
Mailing Address - Country:US
Mailing Address - Phone:772-359-7194
Mailing Address - Fax:772-567-0062
Practice Address - Street 1:1375 US 1 STE 4
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4769
Practice Address - Country:US
Practice Address - Phone:772-567-0061
Practice Address - Fax:772-567-0062
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-18
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119437235Z00000X
FLSA-9345235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA9345OtherFLORIDA SPEECH LANGUAGE LICENSE
TX119437OtherTEXAS DEPARTMENT OF LICENSING AND REGULATION - SPEECH-LANGUAGE PATHOLOGISTS
FL892685900Medicaid