Provider Demographics
NPI:1922359199
Name:SMART, ELAINE JOAN (SLP-CCC, TSSLD)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:JOAN
Last Name:SMART
Suffix:
Gender:F
Credentials:SLP-CCC, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 THROOP AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5327
Mailing Address - Country:US
Mailing Address - Phone:718-654-2055
Mailing Address - Fax:
Practice Address - Street 1:2750 THROOP AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5327
Practice Address - Country:US
Practice Address - Phone:718-654-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023536235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist