Provider Demographics
NPI:1871893982
Name:IJALBA, ELIZABETH (CCC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:IJALBA
Suffix:
Gender:F
Credentials:CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 HAZELWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-3841
Mailing Address - Country:US
Mailing Address - Phone:973-580-7394
Mailing Address - Fax:
Practice Address - Street 1:64 HAZELWOOD AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-3841
Practice Address - Country:US
Practice Address - Phone:973-580-7394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007767-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist