Provider Demographics
NPI:1992926489
Name:ELLIOTT, FREDERICK J
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:J
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 N HIGHWAY 67
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-2034
Mailing Address - Country:US
Mailing Address - Phone:314-830-4484
Mailing Address - Fax:314-830-4494
Practice Address - Street 1:2310NORTH HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033
Practice Address - Country:US
Practice Address - Phone:314-830-4484
Practice Address - Fax:314-830-4494
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007002279237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist