Provider Demographics
NPI:1740434026
Name:HODOVANCE, ELIZABETH A (MA CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:A
Last Name:HODOVANCE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WELLSIDE LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-7844
Mailing Address - Country:US
Mailing Address - Phone:386-447-8081
Mailing Address - Fax:
Practice Address - Street 1:2 WELLSIDE LN
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-7844
Practice Address - Country:US
Practice Address - Phone:386-447-8081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA1415235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA1415OtherFL PROFESSIONAL LICENSE