Provider Demographics
NPI:1801156278
Name:ELLIOTT SPEECH THERAPY, LLC
Entity type:Organization
Organization Name:ELLIOTT SPEECH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP, MANAGING MEMBER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:OTTS
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:225-270-4790
Mailing Address - Street 1:2917 HIGHWAY 171
Mailing Address - Street 2:
Mailing Address - City:HORNBECK
Mailing Address - State:LA
Mailing Address - Zip Code:71439-1420
Mailing Address - Country:US
Mailing Address - Phone:225-270-4790
Mailing Address - Fax:
Practice Address - Street 1:2917 HIGHWAY 171
Practice Address - Street 2:
Practice Address - City:HORNBECK
Practice Address - State:LA
Practice Address - Zip Code:71439-1420
Practice Address - Country:US
Practice Address - Phone:225-270-4790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-20
Last Update Date:2012-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5011235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty