Provider Demographics
NPI:1154400521
Name:GONIDAKIS, ELISSA RUTH (MA CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:ELISSA
Middle Name:RUTH
Last Name:GONIDAKIS
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:MS
Other - First Name:ELISSA
Other - Middle Name:RUTH
Other - Last Name:TOSENBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:199 STONE HEDGE ROW DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43031
Mailing Address - Country:US
Mailing Address - Phone:740-967-1424
Mailing Address - Fax:
Practice Address - Street 1:267 N MAIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43031
Practice Address - Country:US
Practice Address - Phone:740-967-7896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP7987235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist