Healthcare Provider Details

I. General information

NPI: 1881055416
Provider Name (Legal Business Name): ELISABEL CHANG ALVARADO M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELISABEL JIMENEZ CHANG M.S., CCC-SLP

II. Dates (important events)

Enumeration Date: 03/09/2016
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3006 OBSIDIAN TER
ROCKINGHAM VA
22801-3159
US

IV. Provider business mailing address

3006 OBSIDIAN TER
ROCKINGHAM VA
22801-3159
US

V. Phone/Fax

Practice location:
  • Phone: 646-236-2969
  • Fax:
Mailing address:
  • Phone: 646-236-2969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202012050
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: