Provider Demographics
NPI:1548780968
Name:PHAIR, ELISE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:PHAIR
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 1:4302 MAIN CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-8620
Mailing Address - Country:US
Mailing Address - Phone:703-310-8048
Mailing Address - Fax:
Practice Address - Street 1:4302 MAIN CAMPUS DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-8620
Practice Address - Country:US
Practice Address - Phone:703-310-8048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9971235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist