Provider Demographics
NPI:1770615221
Name:SIMPSON, ELIZA BETH BAUCOM (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELIZA BETH
Middle Name:BAUCOM
Last Name:SIMPSON
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 1:1605 COBBLESTONE PKWY
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-5624
Mailing Address - Country:US
Mailing Address - Phone:704-221-0090
Mailing Address - Fax:704-225-9815
Practice Address - Street 1:1605 COBBLESTONE PKWY
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-5624
Practice Address - Country:US
Practice Address - Phone:704-221-0090
Practice Address - Fax:704-225-9815
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC621235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist