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Organization
DAVID SCOTT ELAM
Active
Organization
DAVID SCOTT ELAM
Active
Other names
CROSS SPEECH REHABILITATION AGENCY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID SCOTT ELAM M.A. CCC (DIRECTOR)
(805) 733-4542
Entity
Organization
Contact information
Practice address
191 BURTON MESA BLVD, #D, LOMPOC, CA 93436-1400
(805) 733-4542
(805) 733-4392
Mailing address
191 BURTON MESA BLVD, #D, LOMPOC, CA 93436-1400
(805) 733-4542
(805) 733-4392
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP5420
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0663623
TRIWEST
CA
01
—
ZZZ05144Z
BLUE SHIELD
CA
Enumeration date
06/04/2007
Last updated
05/22/2012
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