Provider Demographics
NPI:1073893210
Name:CANFIELD, ELIZABETH C (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:C
Last Name:CANFIELD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:CC
Other - Middle Name:
Other - Last Name:CANFIELD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:1929 SOUTH 74TH EAST AVENUE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114
Mailing Address - Country:US
Mailing Address - Phone:918-693-9973
Mailing Address - Fax:
Practice Address - Street 1:1929 SOUTH 74TH EAST AVENUE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114
Practice Address - Country:US
Practice Address - Phone:918-693-9973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK497235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist