Provider Demographics
NPI:1104563220
Name:LAURENCE, ELIZABETH WILKEY
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:WILKEY
Last Name:LAURENCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7459 STONEGATE CV
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2015
Mailing Address - Country:US
Mailing Address - Phone:901-270-3955
Mailing Address - Fax:
Practice Address - Street 1:7459 STONEGATE CV
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2015
Practice Address - Country:US
Practice Address - Phone:901-270-3955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000007828235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist