Provider Demographics
NPI:1073896817
Name:DESILVA-ELICH, ELAINE THERESA (CCC-LIC)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:THERESA
Last Name:DESILVA-ELICH
Suffix:
Gender:F
Credentials:CCC-LIC
Other - Prefix:MISS
Other - First Name:ELAINE
Other - Middle Name:THERESA
Other - Last Name:DESILVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-LIC
Mailing Address - Street 1:88 KIRKLAND ROAD
Mailing Address - Street 2:ADLAI E STEVENSON SCHOOL NO 29
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14611
Mailing Address - Country:US
Mailing Address - Phone:585-328-8228
Mailing Address - Fax:585-935-7429
Practice Address - Street 1:88 KIRKLAND RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-3137
Practice Address - Country:US
Practice Address - Phone:585-328-8228
Practice Address - Fax:585-935-7429
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005576-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist