Provider Demographics
NPI:1750566824
Name:ELLIOTT, REBECCCA EVANS (MSP, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:REBECCCA
Middle Name:EVANS
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 PRESBYTERIAN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:SC
Mailing Address - Zip Code:29571-3516
Mailing Address - Country:US
Mailing Address - Phone:843-275-0506
Mailing Address - Fax:
Practice Address - Street 1:214 PRESBYTERIAN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:SC
Practice Address - Zip Code:29571-3516
Practice Address - Country:US
Practice Address - Phone:843-275-0506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3349235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist