Provider Demographics
NPI:1659967149
Name:NEILSON, ELIZABETH MILLER (MS)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MILLER
Last Name:NEILSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 STUBBS AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5629
Mailing Address - Country:US
Mailing Address - Phone:318-388-8414
Mailing Address - Fax:
Practice Address - Street 1:1605 STUBBS AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5629
Practice Address - Country:US
Practice Address - Phone:318-388-8414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116844235Z00000X
LA7130235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty