Provider Demographics
NPI:1124643275
Name:ELSTON, TRICIA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:ELSTON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 DEER RUN
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-6029
Mailing Address - Country:US
Mailing Address - Phone:307-259-7876
Mailing Address - Fax:
Practice Address - Street 1:301 S FENWAY ST STE 202
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-3053
Practice Address - Country:US
Practice Address - Phone:307-337-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1041235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist