Provider Demographics
NPI:1417090614
Name:FARLEY, ELIZABETH SUZANNE (MA)
Entity type:Individual
Prefix:PROF
First Name:ELIZABETH
Middle Name:SUZANNE
Last Name:FARLEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 WESTERN DR
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9547
Mailing Address - Country:US
Mailing Address - Phone:304-562-3226
Mailing Address - Fax:304-562-3226
Practice Address - Street 1:1019 WETHERSFIELD XING
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-8719
Practice Address - Country:US
Practice Address - Phone:304-345-6313
Practice Address - Fax:304-766-5932
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0754235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7402044000Medicaid