Provider Demographics
NPI:1730582768
Name:SMITH, ELIZABETH LOUISE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LOUISE
Last Name:SMITH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 S STAR LAKE RD
Mailing Address - Street 2:MARK TWAIN ELEMENTARY SCHOOL
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6977
Mailing Address - Country:US
Mailing Address - Phone:253-945-3137
Mailing Address - Fax:
Practice Address - Street 1:2450 S STAR LAKE RD
Practice Address - Street 2:MARK TWAIN ELEMENTARY SCHOOL
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6977
Practice Address - Country:US
Practice Address - Phone:253-945-3137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-05
Last Update Date:2014-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 60493204235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist