Provider Demographics
NPI:1003438383
Name:SNOW, ELIZA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELIZA
Middle Name:
Last Name:SNOW
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:LILY
Other - Middle Name:
Other - Last Name:SNOW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:65 BLUE HERON WAY
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-5328
Mailing Address - Country:US
Mailing Address - Phone:781-264-6451
Mailing Address - Fax:
Practice Address - Street 1:751 GRANITE ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-5328
Practice Address - Country:US
Practice Address - Phone:619-647-6157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-10
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30019235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist