Provider Demographics
NPI:1245400134
Name:ROST, ELIZABETH (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:ROST
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2422 WEDGEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17408-9465
Mailing Address - Country:US
Mailing Address - Phone:717-818-1165
Mailing Address - Fax:904-239-3283
Practice Address - Street 1:2422 WEDGEWOOD WAY
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-9465
Practice Address - Country:US
Practice Address - Phone:717-818-1165
Practice Address - Fax:904-239-3283
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-06
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8258235Z00000X
PASL007889235Z00000X
MD06808235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist