Provider Demographics
NPI:1093959678
Name:BAILEY, ELIZABETH GOODMAN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:GOODMAN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:MARY
Other - Last Name:GOODMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:800 W 38TH ST
Mailing Address - Street 2:11103
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1142
Mailing Address - Country:US
Mailing Address - Phone:512-897-7097
Mailing Address - Fax:
Practice Address - Street 1:800 W 38TH ST
Practice Address - Street 2:11103
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1142
Practice Address - Country:US
Practice Address - Phone:512-897-7097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102205235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207779403Medicaid