Provider Demographics
NPI:1447629225
Name:GERRISH, ELAINE JOYCE (MS, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:JOYCE
Last Name:GERRISH
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3119 GRIER BLVD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-6205
Mailing Address - Country:US
Mailing Address - Phone:307-286-2586
Mailing Address - Fax:
Practice Address - Street 1:817 COUNTY ROAD 154
Practice Address - Street 2:
Practice Address - City:CARPENTER
Practice Address - State:WY
Practice Address - Zip Code:82054-9531
Practice Address - Country:US
Practice Address - Phone:307-286-2586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYSP-412235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
09115149OtherASHA CLINICAL COMPETENCY CERTIFICATION