Provider Demographics
NPI:1982029690
Name:STAFFORD, ELIZABETH
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 S GAY ST
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37902-1814
Mailing Address - Country:US
Mailing Address - Phone:865-539-7888
Mailing Address - Fax:
Practice Address - Street 1:912 S GAY ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37902-1814
Practice Address - Country:US
Practice Address - Phone:865-594-1540
Practice Address - Fax:865-594-1531
Is Sole Proprietor?:No
Enumeration Date:2014-03-04
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0000289027OtherPROFESSIONAL SCHOOL SERVICE PERSONNEL LICENSE