Individual
PROF. CAROL ELASSAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1292 CULPEPPER RD, FOREST, MS 39074-9114
(480) 227-9276
Mailing address
1292 CULPEPPER RD, FOREST, MS 39074-9114
(480) 227-9276
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
112156
TX
235Z00000X
Speech-Language Pathologist
7052
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112156
—
TX
05
—
7052
—
TN
Enumeration date
05/13/2020
Last updated
05/13/2020
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