Provider Demographics
NPI:1518102367
Name:GAFFNEY, ELLEN (MS, CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:
Last Name:GAFFNEY
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 1:113 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:RED HOOK
Mailing Address - State:NY
Mailing Address - Zip Code:12571-1146
Mailing Address - Country:US
Mailing Address - Phone:845-758-2260
Mailing Address - Fax:845-758-2260
Practice Address - Street 1:113 KELLY RD
Practice Address - Street 2:
Practice Address - City:RED HOOK
Practice Address - State:NY
Practice Address - Zip Code:12571
Practice Address - Country:US
Practice Address - Phone:845-758-2260
Practice Address - Fax:845-758-2260
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004589-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist