Provider Demographics
NPI:1083756480
Name:WOOLDRIDGE, ELAINE L (MA,CCC)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:L
Last Name:WOOLDRIDGE
Suffix:
Gender:F
Credentials:MA,CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5014 EULACE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-9409
Mailing Address - Country:US
Mailing Address - Phone:904-779-2228
Mailing Address - Fax:904-779-2228
Practice Address - Street 1:5014 EULACE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-9409
Practice Address - Country:US
Practice Address - Phone:904-779-2228
Practice Address - Fax:904-779-2228
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA664235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist