Provider Demographics
NPI:1699201608
Name:FAIRFIELD PEDIATRIC SPEECH THERAPY
Entity Type:Organization
Organization Name:FAIRFIELD PEDIATRIC SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:EVAMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELINSKAS
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:203-685-7622
Mailing Address - Street 1:50 POTTERS LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-3113
Mailing Address - Country:US
Mailing Address - Phone:203-685-7622
Mailing Address - Fax:
Practice Address - Street 1:34 SHERMAN CT
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5826
Practice Address - Country:US
Practice Address - Phone:203-685-7622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004322251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health