Provider Demographics
NPI:1699067991
Name:ALLEN, ELIZABETH L
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:L
Last Name:ALLEN
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 1:3190 ATLANTA HWY
Mailing Address - Street 2:SUITE 15
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-6972
Mailing Address - Country:US
Mailing Address - Phone:706-227-4199
Mailing Address - Fax:
Practice Address - Street 1:3190 ATLANTA HWY
Practice Address - Street 2:SUITE 15
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6972
Practice Address - Country:US
Practice Address - Phone:706-227-4199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADS000801237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter