Provider Demographics
NPI:1679611370
Name:STATHOPOULOS, ELAINE TESS (PHD CCC SLP)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:TESS
Last Name:STATHOPOULOS
Suffix:
Gender:F
Credentials:PHD CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:52 BIOMEDICAL EDUCATION BUILDING
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-8016
Mailing Address - Country:US
Mailing Address - Phone:716-829-3980
Mailing Address - Fax:716-829-3974
Practice Address - Street 1:52 BIOMEDICAL EDUCATION BUILDING
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-8016
Practice Address - Country:US
Practice Address - Phone:716-829-3980
Practice Address - Fax:716-829-3974
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0069451235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00011240404OtherUNIVERA GROUP
000640015003OtherBC CB ADV SB
9210117OtherINDPENDENT HEALTH GROUP