Provider Demographics
NPI:1437448495
Name:ELLIOTT, MELINA (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:MELINA
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 LYNNGROVE DR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-4242
Mailing Address - Country:US
Mailing Address - Phone:310-947-2777
Mailing Address - Fax:
Practice Address - Street 1:1712 LYNNGROVE DR
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-4242
Practice Address - Country:US
Practice Address - Phone:310-947-2777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9961235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist