Provider Demographics
NPI:1548044902
Name:WEBER, ELINOR ROSE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELINOR
Middle Name:ROSE
Last Name:WEBER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 GILLIS ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1810
Mailing Address - Country:US
Mailing Address - Phone:202-441-6964
Mailing Address - Fax:
Practice Address - Street 1:1180 SETON PKWY
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6178
Practice Address - Country:US
Practice Address - Phone:512-504-5162
Practice Address - Fax:512-268-8709
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19905263235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist