Provider Demographics
NPI:1073980017
Name:PITCHON, ELISA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:PITCHON
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 1:3 PERRYOAK PL
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-5017
Mailing Address - Country:US
Mailing Address - Phone:732-216-5325
Mailing Address - Fax:
Practice Address - Street 1:3 PERRYOAK PL
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-5017
Practice Address - Country:US
Practice Address - Phone:732-216-5325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07499235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist