Provider Demographics
NPI:1346675659
Name:CONSTANTINE, ELIZABETH GRAY (SLP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:GRAY
Last Name:CONSTANTINE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:MARSHALL
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:1810 HARPER ST NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-3006
Mailing Address - Country:US
Mailing Address - Phone:404-226-9244
Mailing Address - Fax:
Practice Address - Street 1:1810 HARPER ST NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-3006
Practice Address - Country:US
Practice Address - Phone:404-226-9244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-05
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007434235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist