Provider Demographics
NPI:1417096462
Name:DWYER, ELENA MARIE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ELENA
Middle Name:MARIE
Last Name:DWYER
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 1:14 BOWDEN DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4218
Mailing Address - Country:US
Mailing Address - Phone:631-223-2256
Mailing Address - Fax:
Practice Address - Street 1:104 MAJESTIC DR
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-4935
Practice Address - Country:US
Practice Address - Phone:631-499-5404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015811-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist