Provider Demographics
NPI:1326290412
Name:WEST, ELIZABETH G (MA-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:G
Last Name:WEST
Suffix:
Gender:F
Credentials:MA-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 BEARTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHAZY
Mailing Address - State:NY
Mailing Address - Zip Code:12992-2101
Mailing Address - Country:US
Mailing Address - Phone:518-562-5851
Mailing Address - Fax:518-562-5851
Practice Address - Street 1:58 BEARTOWN RD
Practice Address - Street 2:
Practice Address - City:WEST CHAZY
Practice Address - State:NY
Practice Address - Zip Code:12992-2101
Practice Address - Country:US
Practice Address - Phone:518-562-5851
Practice Address - Fax:518-562-5851
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58-014331235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist