Provider Demographics
NPI:1285095471
Name:WALTERS, ELIZABETH (MS, SLP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19C HIGH STREET
Mailing Address - Street 2:APARTMENT 306
Mailing Address - City:FORT ERIE
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L2A5W9
Mailing Address - Country:CA
Mailing Address - Phone:289-990-5069
Mailing Address - Fax:
Practice Address - Street 1:150 STAHL RD
Practice Address - Street 2:
Practice Address - City:GETZVILLE
Practice Address - State:NY
Practice Address - Zip Code:14068-1231
Practice Address - Country:US
Practice Address - Phone:289-990-5069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist