Provider Demographics
NPI:1669163879
Name:ENNIS, ELIZABETH GRACE (AUD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:GRACE
Last Name:ENNIS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4513 SALERNO CIR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7030
Mailing Address - Country:US
Mailing Address - Phone:469-536-1525
Mailing Address - Fax:
Practice Address - Street 1:5751 EDWARDS RANCH RD STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4152
Practice Address - Country:US
Practice Address - Phone:817-332-8848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81506231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty