Provider Demographics
NPI:1780648477
Name:MCLELLAN, ELIZABETH SWAIN (MS)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:SWAIN
Last Name:MCLELLAN
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 1:989 HICKORY HOLW
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-8540
Mailing Address - Country:US
Mailing Address - Phone:585-271-0680
Mailing Address - Fax:585-442-3357
Practice Address - Street 1:1000 ELMWOOD AVE
Practice Address - Street 2:ROCHESTER HEARING AND SPEECH CENTER
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-3042
Practice Address - Country:US
Practice Address - Phone:585-271-0680
Practice Address - Fax:585-442-3357
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006112235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist