Provider Demographics
NPI:1467802470
Name:LILLEY, ELIZABETH ANGE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANGE
Last Name:LILLEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:R
Other - Last Name:ANGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:PO BOX 2417
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-2417
Mailing Address - Country:US
Mailing Address - Phone:252-355-5535
Mailing Address - Fax:252-355-5536
Practice Address - Street 1:300 E ARLINGTON BLVD
Practice Address - Street 2:SUITE 2B
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5037
Practice Address - Country:US
Practice Address - Phone:252-355-5535
Practice Address - Fax:252-355-5536
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11949235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist