Individual
ELYSE DELPHINE JOHNSON BEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CF-SLP
Contact information
Practice address
14153 RICK DR, SHELBY TOWNSHIP, MI 48315-2951
(586) 566-0326
Mailing address
6862 FOXTHORN RD, CANTON, MI 48187-2677
(313) 806-8082
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7151013455
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7151013455
STATE OF MICHIGAN- DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS
MI
Enumeration date
06/07/2021
Last updated
06/07/2021
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