Provider Demographics
NPI:1710022413
Name:KALOUSTIAN, ELENA
Entity Type:Individual
Prefix:MS
First Name:ELENA
Middle Name:
Last Name:KALOUSTIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6821 EDEN LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-4711
Mailing Address - Country:US
Mailing Address - Phone:813-352-8005
Mailing Address - Fax:813-515-5458
Practice Address - Street 1:6821 EDEN LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-4711
Practice Address - Country:US
Practice Address - Phone:813-243-0730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
252Y00000X
FLSA9469235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000279000Medicaid
FL891983600Medicaid