Healthcare Provider Details

I. General information

NPI: 1669300430
Provider Name (Legal Business Name): ELISE JARVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 TEAKWOOD AVE
COOS BAY OR
97420-2537
US

IV. Provider business mailing address

1350 TEAKWOOD AVE
COOS BAY OR
97420-2537
US

V. Phone/Fax

Practice location:
  • Phone: 541-269-1161
  • Fax: 541-266-4040
Mailing address:
  • Phone: 541-269-1161
  • Fax: 541-266-4040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number011513
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: