Individual
ELYSSA MALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
111 NATURE WALK PKWY, ST AUGUSTINE, FL 32092-5073
(904) 328-7489
Mailing address
111 NATURE WALK PKWY, ST AUGUSTINE, FL 32092-5073
(904) 328-7489
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-19-83010
IN
235Z00000X
Speech-Language Pathologist
Primary
SZ10088
FL
Other
Enumeration date
04/17/2019
Last updated
03/18/2026
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