Provider Demographics
NPI:1831863984
Name:ELLIOTT, BLAIR WORTHINGTON (MSP)
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:WORTHINGTON
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MERRIFIELD DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3338
Mailing Address - Country:US
Mailing Address - Phone:864-561-6397
Mailing Address - Fax:
Practice Address - Street 1:11 MERRIFIELD DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3338
Practice Address - Country:US
Practice Address - Phone:864-561-6397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7341235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty