Provider Demographics
NPI:1518914068
Name:CLINE, ELIZABETH G (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:G
Last Name:CLINE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 LAUREL COVE RD
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-2474
Mailing Address - Country:US
Mailing Address - Phone:704-880-3794
Mailing Address - Fax:704-663-2730
Practice Address - Street 1:6958 NEXUS CT
Practice Address - Street 2:SUITE 102
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2642
Practice Address - Country:US
Practice Address - Phone:910-423-5622
Practice Address - Fax:910-423-5538
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6088235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411998Medicaid
NC1337GOtherBC/BS