Provider Demographics
NPI:1154769297
Name:BARNES, ELAINE LESLIE (MA IECE)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:LESLIE
Last Name:BARNES
Suffix:
Gender:F
Credentials:MA IECE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 OLIVER DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH FULTON
Mailing Address - State:TN
Mailing Address - Zip Code:38257-2450
Mailing Address - Country:US
Mailing Address - Phone:731-335-3397
Mailing Address - Fax:
Practice Address - Street 1:516 OLIVER DR
Practice Address - Street 2:
Practice Address - City:SOUTH FULTON
Practice Address - State:TN
Practice Address - Zip Code:38257-2450
Practice Address - Country:US
Practice Address - Phone:731-335-5450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY200204994252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency