Provider Demographics
NPI:1487714432
Name:DARE, ELIZABETH (AUD, CCC-A)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:DARE
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 DAYTON ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-3805
Mailing Address - Country:US
Mailing Address - Phone:541-884-4428
Mailing Address - Fax:541-850-3847
Practice Address - Street 1:1665 DAYTON ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-3805
Practice Address - Country:US
Practice Address - Phone:541-884-4428
Practice Address - Fax:541-850-3847
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAU 1475231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000VGBHJMedicare ID - Type Unspecified
OR52449Medicare PIN
ORR19301Medicare UPIN