Provider Demographics
NPI:1154879815
Name:ELLIOTT, WESLIE AA (MS)
Entity type:Individual
Prefix:MS
First Name:WESLIE
Middle Name:AA
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 598
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74702-0598
Mailing Address - Country:US
Mailing Address - Phone:580-924-4299
Mailing Address - Fax:580-924-1651
Practice Address - Street 1:1524 CHUCKWA DR
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2142
Practice Address - Country:US
Practice Address - Phone:580-924-4299
Practice Address - Fax:580-924-1651
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4353235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist