Provider Demographics
NPI:1356624720
Name:KRUKOWSKI, ELIZABETH JANE (SLP)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:JANE
Last Name:KRUKOWSKI
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:J
Other - Last Name:QUAIN-KRUKOWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP
Mailing Address - Street 1:218 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-1300
Mailing Address - Country:US
Mailing Address - Phone:607-724-0051
Mailing Address - Fax:
Practice Address - Street 1:221 CHENANGO BRIDGE RD
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901-1293
Practice Address - Country:US
Practice Address - Phone:607-762-6831
Practice Address - Fax:607-762-6895
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004426-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist