Provider Demographics
NPI:1235326125
Name:CORMELL, ELISABETH ANN (SLP)
Entity Type:Individual
Prefix:MRS
First Name:ELISABETH
Middle Name:ANN
Last Name:CORMELL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 KELVINGTON PL
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-4493
Mailing Address - Country:US
Mailing Address - Phone:919-387-5866
Mailing Address - Fax:
Practice Address - Street 1:1602 KELVINGTON PL
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-4493
Practice Address - Country:US
Practice Address - Phone:919-387-5866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2811235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist