Provider Demographics
NPI:1003150905
Name:RICKARDS, ELAINA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:ELAINA
Middle Name:
Last Name:RICKARDS
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 1:207 W SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-2054
Mailing Address - Country:US
Mailing Address - Phone:215-723-2182
Mailing Address - Fax:215-723-2742
Practice Address - Street 1:207 W SUMMIT ST
Practice Address - Street 2:
Practice Address - City:SOUDERTON
Practice Address - State:PA
Practice Address - Zip Code:18964-2054
Practice Address - Country:US
Practice Address - Phone:215-723-2182
Practice Address - Fax:215-723-2742
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL010438235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist