Provider Demographics
NPI:1992279541
Name:DISALVO, ELIZABETH ANN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:DISALVO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10109 W 13TH STREET RD
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-9082
Mailing Address - Country:US
Mailing Address - Phone:716-880-5678
Mailing Address - Fax:
Practice Address - Street 1:5689 MCWHINNEY BLVD
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8826
Practice Address - Country:US
Practice Address - Phone:970-292-8473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0003405235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist