Provider Demographics
NPI:1477749463
Name:FURMANEK, ELIZABETH WIGIM (MA CCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:WIGIM
Last Name:FURMANEK
Suffix:
Gender:F
Credentials:MA CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 SAVAGE RD
Mailing Address - Street 2:STE 400C SUPPLEMENTAL HEALTH CARE
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407
Mailing Address - Country:US
Mailing Address - Phone:866-571-2700
Mailing Address - Fax:843-571-2124
Practice Address - Street 1:1941 SAVAGE RD
Practice Address - Street 2:STE 400C SUPPLEMENTAL HEALTH CARE
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407
Practice Address - Country:US
Practice Address - Phone:866-571-2700
Practice Address - Fax:843-571-2124
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3095235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist