Provider Demographics
NPI:1639482078
Name:HALLIGAN, ELIZABETHE (SLP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETHE
Middle Name:
Last Name:HALLIGAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:ELIZABETHE
Other - Middle Name:
Other - Last Name:HALLIGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:67 SAINT MARKS PL
Mailing Address - Street 2:4B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-7940
Mailing Address - Country:US
Mailing Address - Phone:917-292-3958
Mailing Address - Fax:212-473-4714
Practice Address - Street 1:611 BROADWAY
Practice Address - Street 2:907F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-2608
Practice Address - Country:US
Practice Address - Phone:917-292-3958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008469235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist