Provider Demographics
NPI:1578871968
Name:ABBOTT, ELIZABETH MOLLER (AUDIOLOGIST)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MOLLER
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:ANNA
Other - Last Name:MOLLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUDIOLOGIST
Mailing Address - Street 1:PO BOX 950116
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0116
Mailing Address - Country:US
Mailing Address - Phone:502-893-0159
Mailing Address - Fax:502-213-3884
Practice Address - Street 1:4004 DUPONT CIR
Practice Address - Street 2:SUITE 220
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4819
Practice Address - Country:US
Practice Address - Phone:502-893-0159
Practice Address - Fax:502-213-3853
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0530174400000X, 207Y00000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No174400000XOther Service ProvidersSpecialist
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP400024038Medicare PIN