Provider Demographics
NPI:1467583195
Name:BIZUB, TRISHA MARIE (MA CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:TRISHA
Middle Name:MARIE
Last Name:BIZUB
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 1:8840 AUTUMN WINDS DR APT 308
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-1993
Mailing Address - Country:US
Mailing Address - Phone:919-327-4994
Mailing Address - Fax:
Practice Address - Street 1:3708 MAYFAIR MILL DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-8326
Practice Address - Country:US
Practice Address - Phone:919-752-0766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7237235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist