Provider Demographics
NPI:1992925697
Name:VIA, ELISABETH BURNS (MA,CCC-A)
Entity type:Individual
Prefix:MS
First Name:ELISABETH
Middle Name:BURNS
Last Name:VIA
Suffix:
Gender:F
Credentials:MA,CCC-A
Other - Prefix:MS
Other - First Name:ELISABETH
Other - Middle Name:VIA
Other - Last Name:VIRDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 475
Mailing Address - Street 2:360 CANAL DRIVE WEST
Mailing Address - City:GULF SHORES
Mailing Address - State:AL
Mailing Address - Zip Code:36547-0475
Mailing Address - Country:US
Mailing Address - Phone:251-967-4287
Mailing Address - Fax:
Practice Address - Street 1:1717 NORTH E ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501
Practice Address - Country:US
Practice Address - Phone:850-434-4957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY859231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL797AOtherLICENSE
FLAY859OtherLICENSE