Provider Demographics
NPI:1891216123
Name:SUBA, ELIZABETH ANN (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN
Last Name:SUBA
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:BOEDEKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1003 N CASTELLO ST
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-4529
Mailing Address - Country:US
Mailing Address - Phone:314-915-6724
Mailing Address - Fax:
Practice Address - Street 1:3660 VISTA AVE STE 312
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-2540
Practice Address - Country:US
Practice Address - Phone:314-977-5110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist