Provider Demographics
NPI:1942840939
Name:CAPRINI, ELISSA MICHELLE
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:MICHELLE
Last Name:CAPRINI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 BRUIN DR
Mailing Address - Street 2:
Mailing Address - City:WELLSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26070-3064
Mailing Address - Country:US
Mailing Address - Phone:304-527-1410
Mailing Address - Fax:
Practice Address - Street 1:29 BRUIN DR
Practice Address - Street 2:
Practice Address - City:WELLSBURG
Practice Address - State:WV
Practice Address - Zip Code:26070-3064
Practice Address - Country:US
Practice Address - Phone:304-527-1410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-2022235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVSLP-2022Medicaid