Provider Demographics
NPI:1316318199
Name:DAUGHTREY, ELIZABETH (#33 HIS APPRENTICE)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:DAUGHTREY
Suffix:
Gender:F
Credentials:#33 HIS APPRENTICE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-2140
Mailing Address - Country:US
Mailing Address - Phone:719-468-1013
Mailing Address - Fax:
Practice Address - Street 1:408 W 3RD ST
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-1432
Practice Address - Country:US
Practice Address - Phone:719-384-3277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO#33237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist