Provider Demographics
NPI:1891949228
Name:KADRIBASIC, ELENI (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ELENI
Middle Name:
Last Name:KADRIBASIC
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 1:5127 69TH PL
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-7603
Mailing Address - Country:US
Mailing Address - Phone:646-229-4447
Mailing Address - Fax:347-448-6452
Practice Address - Street 1:5127 69TH PL
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-7603
Practice Address - Country:US
Practice Address - Phone:646-229-4447
Practice Address - Fax:347-448-6452
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015409-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist