Provider Demographics
NPI:1568731057
Name:WILLIAMS, ELAINE DEBRA (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:DEBRA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 KESWICK DR
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-3509
Mailing Address - Country:US
Mailing Address - Phone:631-332-9952
Mailing Address - Fax:
Practice Address - Street 1:263 KESWICK DR
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-3509
Practice Address - Country:US
Practice Address - Phone:631-332-9952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-29
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021198-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist