Provider Demographics
NPI:1679609770
Name:DURYEA, ELISE RACHEL (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ELISE
Middle Name:RACHEL
Last Name:DURYEA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:SAG HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11963-1010
Mailing Address - Country:US
Mailing Address - Phone:631-725-1043
Mailing Address - Fax:631-725-1043
Practice Address - Street 1:21 SOUTH DR
Practice Address - Street 2:
Practice Address - City:SAG HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11963-1010
Practice Address - Country:US
Practice Address - Phone:631-725-1043
Practice Address - Fax:631-725-1043
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010214235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist