Provider Demographics
NPI:1467730267
Name:REISS, ELIZABETH ANNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:REISS
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Gender:F
Credentials:MS, CCC-SLP
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Mailing Address - Street 1:223 E THOUSAND OAKS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5803
Mailing Address - Country:US
Mailing Address - Phone:818-632-9035
Mailing Address - Fax:805-418-9973
Practice Address - Street 1:223 E THOUSAND OAKS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5803
Practice Address - Country:US
Practice Address - Phone:818-632-9035
Practice Address - Fax:805-418-7793
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA19773235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist