Provider Demographics
NPI:1710289244
Name:ELMER, ELIZABETH LEIGH (MS)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:LEIGH
Last Name:ELMER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22269 RIVERGLADE DR
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-1773
Mailing Address - Country:US
Mailing Address - Phone:315-786-6634
Mailing Address - Fax:
Practice Address - Street 1:160 LERAY ST
Practice Address - Street 2:
Practice Address - City:BLACK RIVER
Practice Address - State:NY
Practice Address - Zip Code:13612-2114
Practice Address - Country:US
Practice Address - Phone:315-773-5911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-05
Last Update Date:2010-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006217235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist