Healthcare Provider Details

I. General information

NPI: 1659636629
Provider Name (Legal Business Name): ELIZABETH RYAN SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 APTOS SCHOOL RD
APTOS CA
95003-4005
US

IV. Provider business mailing address

250 APTOS SCHOOL RD
APTOS CA
95003-4005
US

V. Phone/Fax

Practice location:
  • Phone: 831-728-7836
  • Fax:
Mailing address:
  • Phone: 831-728-7836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP 18637
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: