Provider Demographics
NPI:1063200350
Name:CHANG, ELIZABETH (MS)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:CHANG
Suffix:
Gender:
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 WILSHIRE BLVD APT 208
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1480
Mailing Address - Country:US
Mailing Address - Phone:909-447-9276
Mailing Address - Fax:
Practice Address - Street 1:507 WILSHIRE BLVD APT 208
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1480
Practice Address - Country:US
Practice Address - Phone:909-447-9276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24868235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist