Provider Demographics
NPI:1588225536
Name:HOLODNAK, ELYSE MARIE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:MARIE
Last Name:HOLODNAK
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 1:6510 CROSSVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SEVEN HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44131-3109
Mailing Address - Country:US
Mailing Address - Phone:440-539-7144
Mailing Address - Fax:
Practice Address - Street 1:10204 GRANGER RD
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-3106
Practice Address - Country:US
Practice Address - Phone:216-581-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.12969235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist