Provider Demographics
NPI:1730496811
Name:BREEDLOVE, ELIZABETH (M A, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BREEDLOVE
Suffix:
Gender:F
Credentials:M A, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1086 JENKINS BRANCH LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT ULLA
Mailing Address - State:NC
Mailing Address - Zip Code:28125-8699
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1086 JENKINS BRANCH LN
Practice Address - Street 2:
Practice Address - City:MOUNT ULLA
Practice Address - State:NC
Practice Address - Zip Code:28125-8699
Practice Address - Country:US
Practice Address - Phone:704-798-4879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2017-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9005235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist