Provider Demographics
NPI:1710158803
Name:PRESTON, ELIZABETH SUZANNE (AUD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:SUZANNE
Last Name:PRESTON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 BARBARA JORDAN BLVD STE 307
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-3080
Mailing Address - Country:US
Mailing Address - Phone:512-324-9999
Mailing Address - Fax:512-324-2724
Practice Address - Street 1:1301 BARBARA JORDAN BLVD STE 307
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-3080
Practice Address - Country:US
Practice Address - Phone:512-324-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12939231H00000X, 231H00000X
TX81438231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1710158803Medicaid