Provider Demographics
NPI:1376679993
Name:SWEET, ELIZABETH OKEY (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:OKEY
Last Name:SWEET
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9627
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28299-9627
Mailing Address - Country:US
Mailing Address - Phone:704-577-1698
Mailing Address - Fax:815-572-5684
Practice Address - Street 1:711 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-4539
Practice Address - Country:US
Practice Address - Phone:704-577-1698
Practice Address - Fax:815-572-5684
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5961235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411824Medicaid