Provider Demographics
NPI:1063960193
Name:BAGGETT, ELAINA VALSAMAKIS (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ELAINA
Middle Name:VALSAMAKIS
Last Name:BAGGETT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 WOODLAND HTS
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MS
Mailing Address - Zip Code:39730-2806
Mailing Address - Country:US
Mailing Address - Phone:662-369-3721
Mailing Address - Fax:
Practice Address - Street 1:2273 S EASON BLVD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-5900
Practice Address - Country:US
Practice Address - Phone:662-842-2461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3171235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist