Provider Demographics
NPI:1659649804
Name:MARSHALL, ELIZABETH T (MA/CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:T
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MA/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:PO BOX 1687
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24543-1687
Mailing Address - Country:US
Mailing Address - Phone:434-793-8255
Mailing Address - Fax:434-793-6017
Practice Address - Street 1:742 WILSON ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1910
Practice Address - Country:US
Practice Address - Phone:434-793-8255
Practice Address - Fax:434-793-6017
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202000536235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist