Provider Demographics
NPI:1427295625
Name:FORT, ELIZABETH W (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:W
Last Name:FORT
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10133 SPRINGFIELD PIKE
Mailing Address - Street 2:SUITE D
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-1428
Mailing Address - Country:US
Mailing Address - Phone:513-821-0110
Mailing Address - Fax:
Practice Address - Street 1:10133 SPRINGFIELD PIKE
Practice Address - Street 2:SUITE D
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-1428
Practice Address - Country:US
Practice Address - Phone:513-821-0110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-10
Last Update Date:2009-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4082235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist