Provider Demographics
NPI:1740441625
Name:PICKWICK, ELYSE CATHERINE
Entity type:Individual
Prefix:
First Name:ELYSE
Middle Name:CATHERINE
Last Name:PICKWICK
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 1:7455 HOWARDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:KY
Mailing Address - Zip Code:40051-6505
Mailing Address - Country:US
Mailing Address - Phone:270-735-2185
Mailing Address - Fax:270-769-0183
Practice Address - Street 1:7455 HOWARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:KY
Practice Address - Zip Code:40051-6505
Practice Address - Country:US
Practice Address - Phone:270-735-2185
Practice Address - Fax:270-769-0183
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY000069926235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist