Provider Demographics
NPI:1194440495
Name:SHAY, ELIZABETH SUE
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SUE
Last Name:SHAY
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 1:822 COUNTY STREET 2934
Mailing Address - Street 2:
Mailing Address - City:TUTTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73089-2413
Mailing Address - Country:US
Mailing Address - Phone:405-818-4791
Mailing Address - Fax:
Practice Address - Street 1:822 COUNTY STREET 2934
Practice Address - Street 2:
Practice Address - City:TUTTLE
Practice Address - State:OK
Practice Address - Zip Code:73089-2413
Practice Address - Country:US
Practice Address - Phone:405-818-4791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3347235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist