Provider Demographics
NPI:1164803680
Name:CARACCIOLO, ELENA JO (MS, CCC-SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:ELENA
Middle Name:JO
Last Name:CARACCIOLO
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:498 OSWALD RD
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:PA
Mailing Address - Zip Code:16686-7217
Mailing Address - Country:US
Mailing Address - Phone:814-935-9254
Mailing Address - Fax:
Practice Address - Street 1:498 OSWALD RD
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:PA
Practice Address - Zip Code:16686-7217
Practice Address - Country:US
Practice Address - Phone:814-935-9254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL004835L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist