Provider Demographics
NPI:1669725495
Name:GIROD, ELLYSE VIVIAN (SLPA)
Entity type:Individual
Prefix:MRS
First Name:ELLYSE
Middle Name:VIVIAN
Last Name:GIROD
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 W SAINT LUCIA DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-6532
Mailing Address - Country:US
Mailing Address - Phone:650-430-2873
Mailing Address - Fax:
Practice Address - Street 1:1502 W SAINT LUCIA DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-6532
Practice Address - Country:US
Practice Address - Phone:650-430-2873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ80212355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant