Provider Demographics
NPI:1881997021
Name:RODAS, ELLEN SUE (SLP MS CCC)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:SUE
Last Name:RODAS
Suffix:
Gender:F
Credentials:SLP MS CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1062 STATE ROUTE 52
Mailing Address - Street 2:
Mailing Address - City:WALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:12586-1500
Mailing Address - Country:US
Mailing Address - Phone:845-778-2251
Mailing Address - Fax:
Practice Address - Street 1:1062 STATE ROUTE 52
Practice Address - Street 2:
Practice Address - City:WALDEN
Practice Address - State:NY
Practice Address - Zip Code:12586-1500
Practice Address - Country:US
Practice Address - Phone:845-778-2251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003078-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist