Provider Demographics
NPI:1326135302
Name:FELL, ELIZABETH LEA (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LEA
Last Name:FELL
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 1:902 PARKVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:TX
Mailing Address - Zip Code:76643-3264
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1112 N FLOYD RD
Practice Address - Street 2:SUITE 9
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4243
Practice Address - Country:US
Practice Address - Phone:254-744-1604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102540235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist