Provider Demographics
NPI:1023650371
Name:STILES, ELIZABETH (ST)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:STILES
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13220 BIRCH DR STE 200
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-5434
Mailing Address - Country:US
Mailing Address - Phone:402-932-2888
Mailing Address - Fax:402-932-2899
Practice Address - Street 1:13220 BIRCH DR STE 200
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-5434
Practice Address - Country:US
Practice Address - Phone:402-932-2888
Practice Address - Fax:402-932-2899
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2360235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty