Provider Demographics
NPI:1396864898
Name:KONDYLAS, ELISABETH K (MA, CCC, SLP)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:K
Last Name:KONDYLAS
Suffix:
Gender:F
Credentials:MA, 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:PO BOX 12062
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21281-2062
Mailing Address - Country:US
Mailing Address - Phone:410-371-1085
Mailing Address - Fax:
Practice Address - Street 1:16 FUSTING AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-4413
Practice Address - Country:US
Practice Address - Phone:410-747-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3990235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist