Provider Demographics
NPI:1649830910
Name:HURLBURT, ELENA FADER (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:FADER
Last Name:HURLBURT
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 HOP RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:CT
Mailing Address - Zip Code:06238-3231
Mailing Address - Country:US
Mailing Address - Phone:860-716-8724
Mailing Address - Fax:
Practice Address - Street 1:150 HOP RIVER RD
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:CT
Practice Address - Zip Code:06238-3231
Practice Address - Country:US
Practice Address - Phone:860-716-8724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004820235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist