Provider Demographics
NPI:1821226028
Name:FRYDRYK, ELIZABETH L (MS CCC SLP)
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:L
Last Name:FRYDRYK
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5-21 FOREST GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-6665
Mailing Address - Country:US
Mailing Address - Phone:860-303-3037
Mailing Address - Fax:
Practice Address - Street 1:5-21 FOREST GLEN CIR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-6665
Practice Address - Country:US
Practice Address - Phone:860-303-3037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004132235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist