Provider Demographics
NPI:1023565603
Name:MCCOSHEN, ELYSE MARILEE (CCC/SLP)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:MARILEE
Last Name:MCCOSHEN
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:ELYSE
Other - Middle Name:MARILEE
Other - Last Name:GUNDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC/SLP
Mailing Address - Street 1:ESSENTIA HEALTH DULUTH CLINIC MCL2CRED
Mailing Address - Street 2:400 EAST THIRD STREET
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1951
Mailing Address - Country:US
Mailing Address - Phone:218-786-4000
Mailing Address - Fax:
Practice Address - Street 1:ESSENTIA HEALTH ST MARY'S MEDICAL CENTER
Practice Address - Street 2:407 EAST THIRD STREET
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-1950
Practice Address - Country:US
Practice Address - Phone:218-786-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9655235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist