Provider Demographics
NPI:1184127227
Name:KAPOLKA, ELISABETH (SLP)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:KAPOLKA
Suffix:
Gender:
Credentials:SLP
Other - Prefix:
Other - First Name:ELISABETH
Other - Middle Name:
Other - Last Name:SHOVLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:1133 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4003
Mailing Address - Country:US
Mailing Address - Phone:570-714-1246
Mailing Address - Fax:570-714-1249
Practice Address - Street 1:1133 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:FORTY FORT
Practice Address - State:PA
Practice Address - Zip Code:18704-4003
Practice Address - Country:US
Practice Address - Phone:507-714-1246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL013645235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist