Provider Demographics
NPI:1689894503
Name:BURTON, ELIZABETH S (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:S
Last Name:BURTON
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 1:3782 HARDIN ELLISON RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27248-8110
Mailing Address - Country:US
Mailing Address - Phone:336-824-1611
Mailing Address - Fax:
Practice Address - Street 1:3782 HARDIN ELLISON RD
Practice Address - Street 2:
Practice Address - City:FRANKLINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27248-8110
Practice Address - Country:US
Practice Address - Phone:336-824-1611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2834235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7420220Medicaid