Provider Demographics
NPI:1518612639
Name:HINSHAW, ELYSE VAN MATER (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELYSE
Middle Name:VAN MATER
Last Name:HINSHAW
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 E RENNER RD
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-2822
Mailing Address - Country:US
Mailing Address - Phone:214-673-7333
Mailing Address - Fax:
Practice Address - Street 1:5301 E RENNER RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-2822
Practice Address - Country:US
Practice Address - Phone:469-752-6664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist