Provider Demographics
NPI:1841748035
Name:SCHULTZ, ELYSE (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ELYSE
Middle Name:
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 E 23RD ST
Mailing Address - Street 2:APT 17B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4713
Mailing Address - Country:US
Mailing Address - Phone:845-304-0497
Mailing Address - Fax:
Practice Address - Street 1:164 W 79TH ST
Practice Address - Street 2:SUITE 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6439
Practice Address - Country:US
Practice Address - Phone:212-712-3014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist