Provider Demographics
NPI:1578007274
Name:ELLIAS, LAILA MARIE (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAILA
Middle Name:MARIE
Last Name:ELLIAS
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 1:400 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4004
Mailing Address - Country:US
Mailing Address - Phone:917-256-4293
Mailing Address - Fax:917-256-4269
Practice Address - Street 1:400 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4004
Practice Address - Country:US
Practice Address - Phone:917-256-4293
Practice Address - Fax:917-256-4269
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004872235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist