Provider Demographics
NPI:1912492018
Name:DESANTIS-CORREA, ELIZABETH M (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:DESANTIS-CORREA
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 1:59 DEER HILL RD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CT
Mailing Address - Zip Code:06896-2312
Mailing Address - Country:US
Mailing Address - Phone:203-993-5711
Mailing Address - Fax:
Practice Address - Street 1:59 DEER HILL RD
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CT
Practice Address - Zip Code:06896-2312
Practice Address - Country:US
Practice Address - Phone:203-993-5711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-30
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5026235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist