Provider Demographics
NPI:1134574718
Name:HULL, ELIZABETH LAYNE (CCC/SLP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LAYNE
Last Name:HULL
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 1:6724 RAVENDALE LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-2511
Mailing Address - Country:US
Mailing Address - Phone:214-718-1993
Mailing Address - Fax:
Practice Address - Street 1:6724 RAVENDALE LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-2511
Practice Address - Country:US
Practice Address - Phone:214-718-1993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24769235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist