Provider Demographics
NPI:1871348011
Name:HANCOCK, ELIJAH DAVID (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELIJAH
Middle Name:DAVID
Last Name:HANCOCK
Suffix:
Gender:M
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 1:734 SPRINGFORK DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-4960
Mailing Address - Country:US
Mailing Address - Phone:919-389-0451
Mailing Address - Fax:
Practice Address - Street 1:DUKE CLINIC 40 DUKE MEDICINE CIR CLINIC 1I
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-684-3859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30002705235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist