Provider Demographics
NPI:1023433182
Name:RADFORD, ELISE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:RADFORD
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E 9TH ST
Mailing Address - Street 2:APT 20
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-5309
Mailing Address - Country:US
Mailing Address - Phone:203-470-7688
Mailing Address - Fax:
Practice Address - Street 1:700 E 9TH ST
Practice Address - Street 2:APT 20
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-5309
Practice Address - Country:US
Practice Address - Phone:203-470-7688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7875015235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist