Provider Demographics
NPI:1437282779
Name:TRAVIS, ELIZABETH G (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:G
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11103 BREWER CT
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-2275
Mailing Address - Country:US
Mailing Address - Phone:804-740-2407
Mailing Address - Fax:
Practice Address - Street 1:1600 WESTBROOK AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-3337
Practice Address - Country:US
Practice Address - Phone:804-264-6216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202003593235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist