Provider Demographics
NPI:1720234156
Name:PROVEN, ELIZABETH J (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:PROVEN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:J
Other - Last Name:HANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:9031 CRYSTAL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-6414
Mailing Address - Country:US
Mailing Address - Phone:574-265-9338
Mailing Address - Fax:574-265-9338
Practice Address - Street 1:9031 CRYSTAL LAKE DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-6414
Practice Address - Country:US
Practice Address - Phone:574-265-9338
Practice Address - Fax:574-587-9605
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242000963235Z00000X
IL146.011786235Z00000X
IN22004884A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist