Provider Demographics
NPI:1366966111
Name:NASH, ELIZABETH RACHEL
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:RACHEL
Last Name:NASH
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 1:3145 E CHANDLER BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-8702
Mailing Address - Country:US
Mailing Address - Phone:602-320-7517
Mailing Address - Fax:
Practice Address - Street 1:6738 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85035-4642
Practice Address - Country:US
Practice Address - Phone:520-424-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA72052355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSLPA7205OtherARIZONA DEPARTMENT OF HEALTH SERVICES