Provider Demographics
NPI:1598083610
Name:DUNN, ELIZABETH CONCEPCION (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:CONCEPCION
Last Name:DUNN
Suffix:
Gender:F
Credentials:MA CCC-SLP
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Mailing Address - Street 1:2828 LIVINGSTON LOOP
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-2486
Mailing Address - Country:US
Mailing Address - Phone:757-689-2408
Mailing Address - Fax:757-689-2408
Practice Address - Street 1:6401 AUBURN DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-3601
Practice Address - Country:US
Practice Address - Phone:757-420-1485
Practice Address - Fax:757-420-1486
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2202002961235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA311679605Medicare PIN