Provider Demographics
NPI:1033120753
Name:AUSSENBERG, ELIZABETH GRAUBART
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:GRAUBART
Last Name:AUSSENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5230 BIRDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-2504
Mailing Address - Country:US
Mailing Address - Phone:713-668-4717
Mailing Address - Fax:
Practice Address - Street 1:4545 BISSONNET ST STE 215
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3114
Practice Address - Country:US
Practice Address - Phone:713-899-0586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11357235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87881TOtherBCBS PROVIDER NUMBER
TX7088315OtherAETNA PROVIDER NUMBER