Provider Demographics
NPI:1417228180
Name:CARDWELL, ELIZABETH ANN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:CARDWELL
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 1:30359 JIM WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:BUSH
Mailing Address - State:LA
Mailing Address - Zip Code:70431-4165
Mailing Address - Country:US
Mailing Address - Phone:985-789-4800
Mailing Address - Fax:
Practice Address - Street 1:30359 JIM WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:BUSH
Practice Address - State:LA
Practice Address - Zip Code:70431-4165
Practice Address - Country:US
Practice Address - Phone:985-789-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6356235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist