Provider Demographics
NPI:1063662765
Name:BATES, ELIZABETH G (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:G
Last Name:BATES
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 OZARK TRAIL DR.
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011-5533
Mailing Address - Country:US
Mailing Address - Phone:636-386-8886
Mailing Address - Fax:
Practice Address - Street 1:317 OZARK TRAIL DR.
Practice Address - Street 2:SUITE 110
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-5533
Practice Address - Country:US
Practice Address - Phone:636-386-8886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01525235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist