Provider Demographics
NPI:1043959893
Name:GRIFFIN, ELYSABETH ANNAH (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELYSABETH
Middle Name:ANNAH
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HEATHER LN
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-4414
Mailing Address - Country:US
Mailing Address - Phone:770-312-3979
Mailing Address - Fax:
Practice Address - Street 1:225 S PHILPOT ST
Practice Address - Street 2:
Practice Address - City:CEDARTOWN
Practice Address - State:GA
Practice Address - Zip Code:30125-3021
Practice Address - Country:US
Practice Address - Phone:770-748-4116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP011323235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist