Provider Demographics
NPI:1992499453
Name:AIKEN, ELIJAH MARK
Entity type:Individual
Prefix:
First Name:ELIJAH
Middle Name:MARK
Last Name:AIKEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ELI
Other - Middle Name:MARK
Other - Last Name:AIKEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1211 NORMAN RIDGE LN APT 305
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-0657
Mailing Address - Country:US
Mailing Address - Phone:803-920-1975
Mailing Address - Fax:
Practice Address - Street 1:13825 HUNTON LN
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-6190
Practice Address - Country:US
Practice Address - Phone:803-920-1975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30001821235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist