Provider Demographics
NPI:1346317096
Name:MCINTOSH, ELIZABETH F (MED,CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:F
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:MED,CCC-SLP
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:F
Other - Last Name:LARRIMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, CCC-SLP
Mailing Address - Street 1:1206 E 66TH ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-5704
Mailing Address - Country:US
Mailing Address - Phone:912-355-4601
Mailing Address - Fax:912-355-7935
Practice Address - Street 1:1206 E 66TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-5704
Practice Address - Country:US
Practice Address - Phone:912-355-4601
Practice Address - Fax:912-355-7935
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA379235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10052157OtherAMERIGROUP PROVIDER #
GA000563648BMedicaid
GA340955OtherWELLCARE PROVIDER #