Provider Demographics
NPI:1104224559
Name:ELINA, JULIA (MS,CCC-SLP)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:ELINA
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 W 19TH ST
Mailing Address - Street 2:#301
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-3914
Mailing Address - Country:US
Mailing Address - Phone:972-877-6796
Mailing Address - Fax:214-491-5246
Practice Address - Street 1:4141 S BRAESWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-3307
Practice Address - Country:US
Practice Address - Phone:713-666-2651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16811235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist