Basic Information
| Provider Information | |||||||||
| NPI: | 1063187243 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAUS | ||||||||
| FirstName: | ELISE | ||||||||
| MiddleName: | TIFFANY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7410 FOREST TRL APT 206 | ||||||||
| Address2: | |||||||||
| City: | VICTOR | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145649650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6073211742 | ||||||||
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| Practice Location | |||||||||
| Address1: | 590 FISHERS STATION DR STE 130 | ||||||||
| Address2: | |||||||||
| City: | VICTOR | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145649744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859247207 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2021 | ||||||||
| LastUpdateDate: | 09/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 032332 | NY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.