Healthcare Provider Details

I. General information

NPI: 1871374207
Provider Name (Legal Business Name): ELYSE CIPRIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2402 NW 195TH PL
SHORELINE WA
98177-2932
US

IV. Provider business mailing address

2402 NW 195TH PL
SHORELINE WA
98177-2932
US

V. Phone/Fax

Practice location:
  • Phone: 206-364-3777
  • Fax:
Mailing address:
  • Phone: 206-364-3777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLPI.SI.70180263
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: