Provider Demographics
NPI:1174878714
Name:ELAM, HEATHER ELOISE
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:ELOISE
Last Name:ELAM
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:ELOISE
Other - Last Name:ELAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:800 S HARBOR BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-5188
Mailing Address - Country:US
Mailing Address - Phone:949-233-2181
Mailing Address - Fax:657-208-3088
Practice Address - Street 1:800 S HARBOR BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5188
Practice Address - Country:US
Practice Address - Phone:949-233-2181
Practice Address - Fax:657-208-3088
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26962235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP26962OtherSPEECH LANGUAGE PATHOLOGIST