Healthcare Provider Details

I. General information

NPI: 1073420543
Provider Name (Legal Business Name): ELISSA TOBES KAUFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31301 EVERGREEN RD
BEVERLY HILLS MI
48025-3800
US

IV. Provider business mailing address

31301 EVERGREEN RD
BEVERLY HILLS MI
48025-3800
US

V. Phone/Fax

Practice location:
  • Phone: 248-203-3022
  • Fax:
Mailing address:
  • Phone: 248-203-3022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101003091
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: