Provider Demographics
NPI:1043504012
Name:HERNANDEZ, ELIZABETH RUI (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:RUI
Last Name:HERNANDEZ
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 1:1131 E 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85721-0071
Mailing Address - Country:US
Mailing Address - Phone:520-621-7070
Mailing Address - Fax:
Practice Address - Street 1:1131 E. 2ND STREET
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85721-0071
Practice Address - Country:US
Practice Address - Phone:206-217-0705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP7363235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1503509679OtherUNIVERSITY OF ARIZONA