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General NPI Number Information
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NPI Number | 1154840510
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Entity Type | Individual
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Provider Name | ELIZABETH ROSE KYSAR MA CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 09/15/2017
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Last Update Date | 09/15/2017
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Provider Practice Location Address
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Address Line | 30 LANDING CIR STE 103
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City | CHICO
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State | CA
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Zip | 95973-7895
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Country | US
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Telephone | 530-892-9127
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Fax | 530-809-4881
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Provider Business Mailing Address
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Address Line | 5712 BONNIE LANE
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City | PARADISE
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State | CA
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Zip | 95969
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Country | US
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Telephone | 530-570-7524
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP15620
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License Number State | CA
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