Provider Demographics
NPI:1558357798
Name:OCKNER, ELYSE L (MA, CCC-A)
Entity Type:Individual
Prefix:MS
First Name:ELYSE
Middle Name:L
Last Name:OCKNER
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 COOPER LANDING RD
Mailing Address - Street 2:SUITE C-7
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-2517
Mailing Address - Country:US
Mailing Address - Phone:856-667-5110
Mailing Address - Fax:856-667-5119
Practice Address - Street 1:401 COOPER LANDING RD
Practice Address - Street 2:SUITE C-7
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2517
Practice Address - Country:US
Practice Address - Phone:856-667-5110
Practice Address - Fax:856-667-5119
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ149231H00000X
NJ41YA00012700231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2611902Medicaid
NJ2611902Medicaid
NJ206310Medicare ID - Type Unspecified