Provider Demographics
NPI:1851092076
Name:BALLARD, ELIZABETH COX (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:COX
Last Name:BALLARD
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:115 WOODSTOCK DR
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-5746
Mailing Address - Country:US
Mailing Address - Phone:601-415-1016
Mailing Address - Fax:
Practice Address - Street 1:2222 S FRONTAGE RD STE A
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-5271
Practice Address - Country:US
Practice Address - Phone:601-852-3271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS-0752235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist