Provider Demographics
NPI:1821496696
Name:WASHBURN, ELYSSA JEAN (AUD)
Entity Type:Individual
Prefix:DR
First Name:ELYSSA
Middle Name:JEAN
Last Name:WASHBURN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MS
Other - First Name:ELYSSA
Other - Middle Name:JEAN
Other - Last Name:DOOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:1125 S BALL ST
Mailing Address - Street 2:STE 105
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-4038
Mailing Address - Country:US
Mailing Address - Phone:817-722-6156
Mailing Address - Fax:817-722-6159
Practice Address - Street 1:1125 S BALL ST
Practice Address - Street 2:STE 105
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-4038
Practice Address - Country:US
Practice Address - Phone:817-722-6156
Practice Address - Fax:817-722-6159
Is Sole Proprietor?:No
Enumeration Date:2014-12-10
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80854231H00000X
CAHA 7857237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter