MEDICARE: ELIZABETH KRISTEN BASCOM 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	19170	CA

General Provider Information

NPI Number	:	1861281339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH KRISTEN BASCOM M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	1978 PLACER DR
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94578-1337
Country	:	US
Telephone Number	:	510-315-1534
Fax Number	:	510-315-1534

Provider Business Practice Location Address
First Line	:	1978 PLACER DR
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94578-1337
Country	:	US
Telephone Number	:	510-315-1534
Fax Number	:	510-315-1534

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

Provider Enumeration Date	:	05/01/2025
Last Update Date	:	05/01/2025

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