Provider Demographics
NPI:1043973084
Name:ELGOHARY, RAE LYNN DIANE (SLPA)
Entity type:Individual
Prefix:
First Name:RAE LYNN
Middle Name:DIANE
Last Name:ELGOHARY
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8043 VILLA DE NORTE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-3528
Mailing Address - Country:US
Mailing Address - Phone:307-286-8482
Mailing Address - Fax:
Practice Address - Street 1:8043 VILLA DE NORTE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-3528
Practice Address - Country:US
Practice Address - Phone:307-286-8482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX420422355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant