Provider Demographics
NPI:1376679415
Name:MCPHERSON, ELYSE (MS CCC, SLP, CEIS)
Entity type:Individual
Prefix:
First Name:ELYSE
Middle Name:
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:MS CCC, SLP, CEIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 INDIAN POND RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02364-2021
Mailing Address - Country:US
Mailing Address - Phone:781-582-8738
Mailing Address - Fax:
Practice Address - Street 1:195 INDIAN POND RD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MA
Practice Address - Zip Code:02364-2021
Practice Address - Country:US
Practice Address - Phone:781-582-8738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4801235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist