MEDICARE: MS. ELIZABETH ANNE REISS M.S., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	19773	CA

General Provider Information

NPI Number	:	1467730267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH ANNE REISS M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	223 E THOUSAND OAKS BLVD
Second Line	:	SUITE 100
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360-5803
Country	:	US
Telephone Number	:	818-632-9035
Fax Number	:	805-418-9973

Provider Business Practice Location Address
First Line	:	223 E THOUSAND OAKS BLVD
Second Line	:	SUITE 100
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360-5803
Country	:	US
Telephone Number	:	818-632-9035
Fax Number	:	805-418-7793

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2011
Last Update Date	:	11/28/2016

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Directions to “ MS. ELIZABETH ANNE REISS M.S., CCC-SLP” Practice Location

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