Provider Demographics
NPI:1275059867
Name:CRAVENS, ELIZABETH LAURA (MA,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LAURA
Last Name:CRAVENS
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 LAPORTE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-2211
Mailing Address - Country:US
Mailing Address - Phone:970-490-3578
Mailing Address - Fax:
Practice Address - Street 1:2407 LAPORTE AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-2211
Practice Address - Country:US
Practice Address - Phone:970-490-3578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109281235Z00000X
NJ41YS00930100235Z00000X
COSLP.0004217235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist