Individual provider Active NPI

Alisyn Rae Kandybowicz, CCC-SLP

  • Speech-Language Pathologist
  • Flagstaff, AZ
National Provider Identifier
1053853416
Registry record updated Jan 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
10260 Issued in AZ
Practice address
6525 Johnson Ranch Rd
Flagstaff, AZ 86004-8327
Phone
(602) 284-5406
Fax
(602) 297-6516
NPI assigned
Nov 16, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 10260 AZ Primary

Addresses

Primary practice location

6525 Johnson Ranch Rd
Flagstaff, AZ 86004-8327

Mailing address

6525 Johnson Ranch Rd
Flagstaff, AZ 86004-8327
Phone (602) 284-5406

Other identifiers 1

IdentifierTypeStateIssuer
104201MedicaidAZ

Other names 1

  • Alisyn Rae McElvain Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
10260AZMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Early Intervention and Consultation Services, LLC PastSince Apr 30, 2023 Accepting new patients
County of Maricopa Creighton Elementary School Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1479254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769040000000",
    "number": "1053853416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6525 JOHNSON RANCH RD",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860048327",
            "telephone_number": "602-284-5406",
            "fax_number": "602-297-6516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6525 JOHNSON RANCH RD",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860048327",
            "telephone_number": "602-284-5406",
            "fax_number": "602-297-6516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANDYBOWICZ",
        "first_name": "ALISYN",
        "middle_name": "RAE",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-16",
        "last_updated": "2026-01-22",
        "certification_date": "2026-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AZ",
            "license": "10260",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104201",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALISYN",
            "last_name": "MCELVAIN",
            "middle_name": "RAE",
            "credential": "ALISYN RAE JORDAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Flagstaff, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.