Provider Demographics
NPI:1952515868
Name:PYCRAFT, ELYSE L (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:L
Last Name:PYCRAFT
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:ELYSE
Other - Middle Name:L
Other - Last Name:MCDAID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:966 BUCHOLZ DR
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-2618
Mailing Address - Country:US
Mailing Address - Phone:330-317-0487
Mailing Address - Fax:
Practice Address - Street 1:966 BUCHOLZ DR
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-2618
Practice Address - Country:US
Practice Address - Phone:330-317-0487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.9709235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2646524Medicaid