Provider Demographics
NPI:1689879579
Name:SPENCE, ELIZABETH B (CFY SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:B
Last Name:SPENCE
Suffix:
Gender:F
Credentials:CFY SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 S DOBSON RD
Mailing Address - Street 2:STE 212
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-5664
Mailing Address - Country:US
Mailing Address - Phone:480-456-0719
Mailing Address - Fax:
Practice Address - Street 1:1819 S DOBSON RD
Practice Address - Street 2:STE 212
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-5664
Practice Address - Country:US
Practice Address - Phone:480-456-0719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP5536235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ222871Medicaid