Provider Demographics
NPI:1669093183
Name:EXPRESSIVE ELEVATION, P.C.
Entity type:Organization
Organization Name:EXPRESSIVE ELEVATION, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP, TSHH
Authorized Official - Phone:347-721-8439
Mailing Address - Street 1:1462 FORCE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-1708
Mailing Address - Country:US
Mailing Address - Phone:347-721-8439
Mailing Address - Fax:
Practice Address - Street 1:1462 FORCE DR
Practice Address - Street 2:
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-1708
Practice Address - Country:US
Practice Address - Phone:347-721-8439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech