Provider Demographics
NPI:1568749166
Name:MCELROY, COLLEEN ROSE (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:ROSE
Last Name:MCELROY
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1145 BARRY AVE
Mailing Address - Street 2:APT. 203
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6249
Mailing Address - Country:US
Mailing Address - Phone:716-913-7108
Mailing Address - Fax:
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0005
Practice Address - Country:US
Practice Address - Phone:716-913-7108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18419235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist