Provider Demographics
NPI:1598751042
Name:MCLEAN, ELIZABETH WATERS (SLP/CCC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:WATERS
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:SLP/CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39TH MEDICAL GROUP
Mailing Address - Street 2:UNIT 7095 BOX 185
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09824
Mailing Address - Country:TR
Mailing Address - Phone:01190322-316-3380
Mailing Address - Fax:
Practice Address - Street 1:39TH MEDICAL GROUP
Practice Address - Street 2:UNIT 7095 BOX 185
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09824
Practice Address - Country:TR
Practice Address - Phone:01190322-316-3380
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004283235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist