Provider Demographics
NPI:1114553237
Name:WALDRON, ELIZABETH MARIE
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MARIE
Last Name:WALDRON
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 1:653 RTE 46 W STE 3
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-1595
Mailing Address - Country:US
Mailing Address - Phone:973-227-0750
Mailing Address - Fax:
Practice Address - Street 1:653 RTE 46 W STE 3
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-1595
Practice Address - Country:US
Practice Address - Phone:973-227-0750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MG00134600237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist