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Individual
ELAINE TESS STATHOPOULOS
Active
Individual
ELAINE TESS STATHOPOULOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD CCC SLP
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
0069451
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00011240404
UNIVERA GROUP
—
01
—
000640015003
BC CB ADV SB
—
01
—
9210117
INDPENDENT HEALTH GROUP
—
Enumeration date
02/02/2007
Last updated
07/08/2007
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