Provider Demographics
NPI:1255477139
Name:KALIL, ELIZABETH NORTHINGTON (MA CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:NORTHINGTON
Last Name:KALIL
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19 EASTLAWN RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1912
Mailing Address - Country:US
Mailing Address - Phone:207-650-0264
Mailing Address - Fax:
Practice Address - Street 1:19 EASTLAWN RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-1912
Practice Address - Country:US
Practice Address - Phone:207-650-0264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1194235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME316060099Medicaid
ME027862OtherANTHEM BCBS