Healthcare Provider Details

I. General information

NPI: 1568372886
Provider Name (Legal Business Name): ELISE HISKENS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8850 WHITTAKER RD
YPSILANTI MI
48197-9435
US

IV. Provider business mailing address

19 S NORMAL ST
YPSILANTI MI
48197-4732
US

V. Phone/Fax

Practice location:
  • Phone: 734-484-7000
  • Fax:
Mailing address:
  • Phone: 734-450-1385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101009548
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: