Provider Demographics
NPI:1932879533
Name:HOPKINS GALLEGOS, ELISE
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:HOPKINS GALLEGOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 ARGYLE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1704
Mailing Address - Country:US
Mailing Address - Phone:860-707-3109
Mailing Address - Fax:
Practice Address - Street 1:18 N MAIN ST STE 2E
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-9103
Practice Address - Country:US
Practice Address - Phone:860-707-3109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006685235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist