Basic Information
| Provider Information | |||||||||
| NPI: | 1508042623 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELLIOTT | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | JONES | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27730 SAN PORTOLA | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782601852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7723597194 | ||||||||
| FaxNumber: | 7725670062 | ||||||||
| Practice Location | |||||||||
| Address1: | 1375 US 1 STE 4 | ||||||||
| Address2: | |||||||||
| City: | VERO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329604769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7725670061 | ||||||||
| FaxNumber: | 7725670062 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2008 | ||||||||
| LastUpdateDate: | 09/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 119437 | TX | N | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | SA-9345 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | SA9345 | 01 | FL | FLORIDA SPEECH LANGUAGE LICENSE | OTHER | 119437 | 01 | TX | TEXAS DEPARTMENT OF LICENSING AND REGULATION - SPEECH-LANGUAGE PATHOLOGISTS | OTHER | 892685900 | 05 | FL | MEDICAID |