Provider Demographics
NPI:1326280215
Name:KHASHCHEVATSKAYA, YELENA (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:YELENA
Middle Name:
Last Name:KHASHCHEVATSKAYA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-3402
Mailing Address - Country:US
Mailing Address - Phone:917-293-2238
Mailing Address - Fax:718-948-0322
Practice Address - Street 1:355 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-3402
Practice Address - Country:US
Practice Address - Phone:917-293-2238
Practice Address - Fax:718-948-0322
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014874235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist