Provider Demographics
NPI:1376664227
Name:COVINGTON, ELIZABETH DE SOMERY (MA CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:DE SOMERY
Last Name:COVINGTON
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
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Mailing Address - Street 1:55 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:LUNENBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01462-1001
Mailing Address - Country:US
Mailing Address - Phone:978-582-3338
Mailing Address - Fax:
Practice Address - Street 1:977 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-7406
Practice Address - Country:US
Practice Address - Phone:781-899-4709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1652235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0371815Medicaid