Provider Demographics
NPI:1407131170
Name:ELWELL, MARY MARGARET (CCC/LSP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MARGARET
Last Name:ELWELL
Suffix:
Gender:F
Credentials:CCC/LSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 DRUMLIN CT
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1863
Mailing Address - Country:US
Mailing Address - Phone:315-332-7400
Mailing Address - Fax:
Practice Address - Street 1:4440 RIDGE RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:NY
Practice Address - Zip Code:14589-9382
Practice Address - Country:US
Practice Address - Phone:315-589-2400
Practice Address - Fax:315-589-2670
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003669-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist