Provider Demographics
NPI:1609176858
Name:STEPHAN, ELAINE M (MS, CCC/LSLP)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:M
Last Name:STEPHAN
Suffix:
Gender:F
Credentials:MS, CCC/LSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1291 ROUTE 16 S
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-9683
Mailing Address - Country:US
Mailing Address - Phone:716-373-5505
Mailing Address - Fax:
Practice Address - Street 1:411 W HENLEY ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-3541
Practice Address - Country:US
Practice Address - Phone:716-375-8940
Practice Address - Fax:716-375-8950
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006822235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist