Provider Demographics
NPI:1932396637
Name:GEORGALAS, ELANA MARIE (SLP-CCC)
Entity Type:Individual
Prefix:MRS
First Name:ELANA
Middle Name:MARIE
Last Name:GEORGALAS
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SOMA LN
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-1807
Mailing Address - Country:US
Mailing Address - Phone:917-902-2036
Mailing Address - Fax:
Practice Address - Street 1:17 SOMA LN
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-1807
Practice Address - Country:US
Practice Address - Phone:917-902-2036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016623235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist