MEDICARE: ELISSA POLLAND 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	015148-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	015148-1	OTHER	NY	NEW YORK STATE EDUCATION DEPARTMENT DIVISION OF PROFESSIONAL LICENSING SERVICES

General Provider Information

NPI Number	:	1659659910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISSA POLLAND MS, CCC/SLP

Provider Business Mailing Address
First Line	:	966 GERRY AVE
Second Line	:
City	:	LIDO BEACH
State	:	NY
Zip	:	11561-5217
Country	:	US
Telephone Number	:	516-850-1348
Fax Number	:

Provider Business Practice Location Address
First Line	:	966 GERRY AVE
Second Line	:
City	:	LIDO BEACH
State	:	NY
Zip	:	11561-5217
Country	:	US
Telephone Number	:	516-850-1348
Fax Number	:

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

Provider Enumeration Date	:	08/03/2011
Last Update Date	:	08/03/2011

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Directions to “ ELISSA POLLAND MS, CCC/SLP” Practice Location

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