Provider Demographics
NPI:1578714887
Name:SPICER, ELIZABETH ANN (SLP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANN
Last Name:SPICER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:SPICER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:608 FRANQUETTE AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-7832
Mailing Address - Country:US
Mailing Address - Phone:541-858-1793
Mailing Address - Fax:
Practice Address - Street 1:608 FRANQUETTE AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-7832
Practice Address - Country:US
Practice Address - Phone:541-858-1793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10217235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist