Provider Demographics
NPI:1356885354
Name:GANZFRIED, ELLAYNE S (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELLAYNE
Middle Name:S
Last Name:GANZFRIED
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 MIDDLE NECK RD
Mailing Address - Street 2:APT 5J
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1203
Mailing Address - Country:US
Mailing Address - Phone:516-659-1718
Mailing Address - Fax:
Practice Address - Street 1:160 MIDDLE NECK RD
Practice Address - Street 2:APT 5J
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-1203
Practice Address - Country:US
Practice Address - Phone:516-659-1718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0059831235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist