Provider Demographics
NPI:1134415441
Name:ELLIOTT, ANN DRISCOLL
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:DRISCOLL
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 ROBY AVE.
Mailing Address - Street 2:OCM BOCES CHILDREN'S VILLAGE @ PARK HILL SCHOOL
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057
Mailing Address - Country:US
Mailing Address - Phone:315-434-3830
Mailing Address - Fax:
Practice Address - Street 1:303 ROBY AVE.
Practice Address - Street 2:OCM BOCES CHILDREN'S VILLAGE @ PARK HILL SCHOOL
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057
Practice Address - Country:US
Practice Address - Phone:315-434-3830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002390-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY002390-1OtherNYS LICENSE SPEECH PATHOLOGY
NY00687632OtherAMERICAN SPEECH LANGUAGE HEARING ASSOCIATION CCC