Provider Demographics
NPI:1760516082
Name:RISSMILLER, ELIZABETH M (MA CCC/SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:RISSMILLER
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 1:640 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44303-1413
Mailing Address - Country:US
Mailing Address - Phone:330-762-7542
Mailing Address - Fax:330-762-4019
Practice Address - Street 1:640 W MARKET ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44303-1413
Practice Address - Country:US
Practice Address - Phone:330-762-7542
Practice Address - Fax:330-762-4019
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.8779235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist