Provider Demographics
NPI:1972962025
Name:KADEN, ELYSSA RAE (MS, CCC-SLP, TSSLD)
Entity type:Individual
Prefix:
First Name:ELYSSA
Middle Name:RAE
Last Name:KADEN
Suffix:
Gender:F
Credentials:MS, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 JUNEAU BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2611
Mailing Address - Country:US
Mailing Address - Phone:516-457-7011
Mailing Address - Fax:
Practice Address - Street 1:28 JUNEAU BLVD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2611
Practice Address - Country:US
Practice Address - Phone:516-457-7011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-17
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026243235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist