Provider Demographics
NPI:1275708281
Name:ROCK, ELIZABETH R (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:R
Last Name:ROCK
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 1:9604 SPLENDOR DR
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:KY
Mailing Address - Zip Code:41091-6917
Mailing Address - Country:US
Mailing Address - Phone:859-391-1476
Mailing Address - Fax:
Practice Address - Street 1:9604 SPLENDOR DR
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:KY
Practice Address - Zip Code:41091-6917
Practice Address - Country:US
Practice Address - Phone:859-391-1476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-2832235Z00000X
OHSP-7698235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist