Provider Demographics
NPI:1063888733
Name:MCELRATH, LESLI OVERBEY (MA)
Entity type:Individual
Prefix:MRS
First Name:LESLI
Middle Name:OVERBEY
Last Name:MCELRATH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 LANE 345 CROOKED LK
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46703-7001
Mailing Address - Country:US
Mailing Address - Phone:281-536-0471
Mailing Address - Fax:
Practice Address - Street 1:175 LANE 345 CROOKED LK
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-7001
Practice Address - Country:US
Practice Address - Phone:281-536-0471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22005807A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist