MEDICARE: ELIZABETH WYCHE STRATTON M.S. 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	510779B	WA
2	235Z00000X	Speech-Language Pathologist	27786	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27786	OTHER	CA	STATE OF CALIFORNIA SLP LICENCE

General Provider Information

NPI Number	:	1497153696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH WYCHE STRATTON M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	5000 NE 72ND AVE APT L75
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98661-8170
Country	:	US
Telephone Number	:	360-909-7278
Fax Number	:

Provider Business Practice Location Address
First Line	:	2942 KALMIA ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-5415
Country	:	US
Telephone Number	:	603-909-7278
Fax Number	:

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

Provider Enumeration Date	:	12/21/2014
Last Update Date	:	10/11/2018

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Directions to “ ELIZABETH WYCHE STRATTON M.S. CCC-SLP” Practice Location

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