Provider Demographics
NPI:1477107795
Name:MILNES, ELIZA JEAN (MS, CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:ELIZA
Middle Name:JEAN
Last Name:MILNES
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:ELIZA
Other - Middle Name:JEAN
Other - Last Name:NEWCOMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP/L
Mailing Address - Street 1:3322 S ROCKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3236
Mailing Address - Country:US
Mailing Address - Phone:717-808-3613
Mailing Address - Fax:
Practice Address - Street 1:3510 SILVERSIDE RD STE 2
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4937
Practice Address - Country:US
Practice Address - Phone:717-808-3613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-25
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007689235Z00000X
DEO1-0001675235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist