Provider Demographics
NPI:1275818213
Name:MACCHIO, ELAINE A (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:A
Last Name:MACCHIO
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 1:400 MADISON ST
Mailing Address - Street 2:APT.1003
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-1772
Mailing Address - Country:US
Mailing Address - Phone:703-549-2134
Mailing Address - Fax:
Practice Address - Street 1:400 MADISON ST
Practice Address - Street 2:APT.1003
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-1772
Practice Address - Country:US
Practice Address - Phone:703-549-2134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004974235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist