Individual provider Active NPI

Elizabeth Anne Commissaris

  • Speech-Language Pathologist
  • Eagle River, AK
National Provider Identifier
1639744246
Registry record updated May 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
177779 Issued in AK
Practice address
12812 Old Glenn Hwy Ste B2
Eagle River, AK 99577-7002
Phone
(907) 290-9595
NPI assigned
May 25, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 25, 2021

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 177779 AK Primary

Addresses

Primary practice location

12812 Old Glenn Hwy Ste B2
Eagle River, AK 99577-7002

Mailing address

1841 S Itasca Cir
Wasilla, AK 99654-9747
Phone (907) 232-5057

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
177779AKMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1621900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621900800000",
    "number": "1639744246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1841 S ITASCA CIR",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996549747",
            "telephone_number": "907-232-5057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12812 OLD GLENN HWY STE B2",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "995777002",
            "telephone_number": "907-290-9595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COMMISSARIS",
        "first_name": "ELIZABETH",
        "middle_name": "ANNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-25",
        "last_updated": "2021-05-25",
        "certification_date": "2021-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AK",
            "license": "177779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagle River, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2021; 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.