Provider Demographics
NPI:1730327404
Name:ELISHA'S SPEECH AND LANGUAGE SERVICES, LLC.
Entity type:Organization
Organization Name:ELISHA'S SPEECH AND LANGUAGE SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELISHA
Authorized Official - Middle Name:ROKIA
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:SLP/OWNER
Authorized Official - Phone:228-865-0117
Mailing Address - Street 1:3506 WASHINGTON AVENUE
Mailing Address - Street 2:STE. E
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507
Mailing Address - Country:US
Mailing Address - Phone:228-865-0117
Mailing Address - Fax:228-865-0119
Practice Address - Street 1:3506 WASHINGTON AVENUE
Practice Address - Street 2:STE. E
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507
Practice Address - Country:US
Practice Address - Phone:228-865-0117
Practice Address - Fax:228-865-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No273Y00000XHospital UnitsRehabilitation Unit