Active NPI
Elyse Sutherland, CCC-SLP
- Speech-Language Pathologist
- Rohnert Park, CA
National Provider Identifier
1710552328
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 30591
- Practice address
- 710 Rohnert Park Expy E
Rohnert Park, CA 94928-1514 - Phone
- (925) 338-1531
- NPI assigned
- May 25, 2021
- Last updated
- May 27, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 30591 | CA | Primary |
Addresses
Primary practice location
710 Rohnert Park Expy E
Rohnert Park, CA 94928-1514
Mailing address
2000 Clay Bank Rd Apt C3
Fairfield, CA 94533-2502
Phone (302) 490-8145
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30591 | CA | MD | Speech-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": "1622073600000",
"number": "1710552328",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2000 CLAY BANK RD APT C3",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945332502",
"telephone_number": "302-490-8145"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "710 ROHNERT PARK EXPY E",
"city": "ROHNERT PARK",
"state": "CA",
"postal_code": "949281514",
"telephone_number": "925-338-1531"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUTHERLAND",
"first_name": "ELYSE",
"credential": "CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-05-25",
"last_updated": "2021-05-27",
"certification_date": "2021-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "30591",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rohnert Park, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 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.