Provider Demographics
NPI:1386357614
Name:D'AGOSTINO, ELIZABETH GRACE
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:GRACE
Last Name:D'AGOSTINO
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 1:21 ERIE BLVD
Mailing Address - Street 2:APT 54
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12204
Mailing Address - Country:US
Mailing Address - Phone:719-244-1603
Mailing Address - Fax:
Practice Address - Street 1:2841 THOUSAND ACRES RD
Practice Address - Street 2:
Practice Address - City:DELANSON
Practice Address - State:NY
Practice Address - Zip Code:12053-1917
Practice Address - Country:US
Practice Address - Phone:518-875-6141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist