Provider Demographics
NPI:1528722840
Name:NEAL, ELIZABETH J (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:J
Last Name:NEAL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:BETTY
Other - Middle Name:J
Other - Last Name:NEAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:PO BOX 3524
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:CO
Mailing Address - Zip Code:81631-3524
Mailing Address - Country:US
Mailing Address - Phone:970-445-7462
Mailing Address - Fax:
Practice Address - Street 1:180 SOUTH FRONTAGE ROAD WEST
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:CO
Practice Address - Zip Code:81657
Practice Address - Country:US
Practice Address - Phone:970-476-2451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0004205235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist