MEDICARE: ELISA KINGSBURY M.S.

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	10375	CA

General Provider Information

NPI Number	:	1770414849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISA KINGSBURY M.S.

Provider Business Mailing Address
First Line	:	2020 BONAR ST STE 303
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94702-1793
Country	:	US
Telephone Number	:	510-644-6210
Fax Number	:

Provider Business Practice Location Address
First Line	:	1460 8TH ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94710-1434
Country	:	US
Telephone Number	:	510-644-6339
Fax Number	:

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

Provider Enumeration Date	:	05/27/2026
Last Update Date	:	05/27/2026

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Directions to “ ELISA KINGSBURY M.S.” Practice Location

Language	Start Address	Practice Location

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