Provider Demographics
NPI:1528355419
Name:OKSANISH, ELENA M (M ED CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:ELENA
Middle Name:M
Last Name:OKSANISH
Suffix:
Gender:F
Credentials:M ED CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1048 LANCASTER ST
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-4559
Mailing Address - Country:US
Mailing Address - Phone:401-465-3004
Mailing Address - Fax:
Practice Address - Street 1:1048 LANCASTER ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-4559
Practice Address - Country:US
Practice Address - Phone:401-465-3004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASP8143235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist