Healthcare Provider Details

I. General information

NPI: 1639751985
Provider Name (Legal Business Name): ELISE SIPRELLE SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 DAVIS LN BLDG A
AUSTIN TX
78749-4071
US

IV. Provider business mailing address

1101 W 34TH ST # 231
AUSTIN TX
78705-1907
US

V. Phone/Fax

Practice location:
  • Phone: 512-301-8747
  • Fax:
Mailing address:
  • Phone: 214-546-6118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number106497
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: