Provider Demographics
NPI:1275874513
Name:CLIFFORD, ELIZABETH ANN (MHS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:MHS CCC-SLP
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:ANN
Other - Last Name:CLIFFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MHS CCC-SLP
Mailing Address - Street 1:235 WARD PKWY
Mailing Address - Street 2:APT 403
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-2139
Mailing Address - Country:US
Mailing Address - Phone:816-547-8824
Mailing Address - Fax:
Practice Address - Street 1:351 NORTHWEST GREGORY
Practice Address - Street 2:
Practice Address - City:LEE'S SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064
Practice Address - Country:US
Practice Address - Phone:816-478-0381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011019420235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOLUKE22Medicaid