Provider Demographics
NPI:1720473770
Name:ERNST, LIA KOTSOPOULOS (MED CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LIA
Middle Name:KOTSOPOULOS
Last Name:ERNST
Suffix:
Gender:F
Credentials:MED 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:PO BOX 1414
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28329-1414
Mailing Address - Country:US
Mailing Address - Phone:910-299-0700
Mailing Address - Fax:910-299-0800
Practice Address - Street 1:620 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-3502
Practice Address - Country:US
Practice Address - Phone:910-299-0700
Practice Address - Fax:910-299-0800
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11275235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist