Provider Demographics
NPI:1144508599
Name:DR. ALICIA A. ELLIOTT SPEECH PATHOLOGY, INC.
Entity type:Organization
Organization Name:DR. ALICIA A. ELLIOTT SPEECH PATHOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/SPEECH PATHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:818-236-3603
Mailing Address - Street 1:2506 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-3506
Mailing Address - Country:US
Mailing Address - Phone:818-236-3603
Mailing Address - Fax:818-236-2106
Practice Address - Street 1:2506 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-3506
Practice Address - Country:US
Practice Address - Phone:818-236-3603
Practice Address - Fax:818-236-2106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4207235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty