Provider Demographics
NPI:1245476548
Name:CONLON, ELIZABETH (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:CONLON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 MAIN ST
Mailing Address - Street 2:ATHOL MEMORIAL HOSPITAL
Mailing Address - City:ATHOL
Mailing Address - State:MA
Mailing Address - Zip Code:01331-3535
Mailing Address - Country:US
Mailing Address - Phone:978-249-1201
Mailing Address - Fax:978-249-5608
Practice Address - Street 1:2033 MAIN ST
Practice Address - Street 2:ATHOL MEMORIAL HOSPITAL
Practice Address - City:ATHOL
Practice Address - State:MA
Practice Address - Zip Code:01331-3535
Practice Address - Country:US
Practice Address - Phone:978-249-1201
Practice Address - Fax:978-249-5608
Is Sole Proprietor?:No
Enumeration Date:2008-12-17
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003843235Z00000X
MA8668235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist