MEDICARE: ELIZABETH M DESANTIS-CORREA MS CCC SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	5026	CT

General Provider Information

NPI Number	:	1912492018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH M DESANTIS-CORREA MS CCC SLP

Provider Business Mailing Address
First Line	:	59 DEER HILL RD
Second Line	:
City	:	REDDING
State	:	CT
Zip	:	06896-2312
Country	:	US
Telephone Number	:	203-993-5711
Fax Number	:

Provider Business Practice Location Address
First Line	:	59 DEER HILL RD
Second Line	:
City	:	REDDING
State	:	CT
Zip	:	06896-2312
Country	:	US
Telephone Number	:	203-993-5711
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2018
Last Update Date	:	08/18/2023

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