Provider Demographics
NPI:1548207665
Name:CLARKSDALE SPEECH AND HEARING CENTER
Entity Type:Organization
Organization Name:CLARKSDALE SPEECH AND HEARING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ROBERTSON
Authorized Official - Last Name:LANEY
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:662-627-5247
Mailing Address - Street 1:1742 CHERYL ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-7218
Mailing Address - Country:US
Mailing Address - Phone:662-627-5247
Mailing Address - Fax:662-627-1739
Practice Address - Street 1:1742 CHERYL ST
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-7218
Practice Address - Country:US
Practice Address - Phone:662-627-5247
Practice Address - Fax:662-627-1739
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLARKSDALE SPEECH AND HEARING CENTER/ ELIZABETH LANEY AU.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-31
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
231H00000X, 235Z00000X
MSA0351231H00000X
MSHAO349237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Not Answered237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS9011008Medicaid