Provider Demographics
NPI:1861649543
Name:MILLS, ELIZABETH A (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:MILLS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2851 STAGE VILLAGE CV STE 6
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-4683
Mailing Address - Country:US
Mailing Address - Phone:901-388-4775
Mailing Address - Fax:
Practice Address - Street 1:2851 STAGE VILLAGE CV STE 6
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-4683
Practice Address - Country:US
Practice Address - Phone:901-388-4775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP4552235Z00000X
TNSP0000001347235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist