Individual
ALIZA ELLENWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA CCC/SLP
Contact information
Practice address
430 LAKEVILLE RD, NEW HYDE PARK, NY 11042-1121
(718) 470-7550
Mailing address
31 FORSYTHIA LN, JERICHO, NY 11753-2335
(516) 817-1379
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
013313-01
NY
Other
Enumeration date
12/22/2022
Last updated
12/22/2022
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