Provider Demographics
NPI:1598383820
Name:SCOTT, ELISABETH HOLLISTER (MS)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:HOLLISTER
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2370 FRANCISCO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-1912
Mailing Address - Country:US
Mailing Address - Phone:916-833-9130
Mailing Address - Fax:
Practice Address - Street 1:2370 FRANCISCO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-1912
Practice Address - Country:US
Practice Address - Phone:916-833-9130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28681235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9168339130OtherGOLDEN GATE REGIONAL CENTER
CA9168339130OtherKAISER PERMENENTE