Provider Demographics
NPI:1568705994
Name:OLIVER, ELIZABETH DIANE (MS-CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:DIANE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:MS-CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-6401
Mailing Address - Country:US
Mailing Address - Phone:812-890-7862
Mailing Address - Fax:
Practice Address - Street 1:1511 CLARK ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-6401
Practice Address - Country:US
Practice Address - Phone:812-890-7862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003141A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN22003141AOtherINDIANA PROFESSIONAL LICENSING AGENCY
09134645OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION