Provider Demographics
NPI:1811411788
Name:FERGUSON, ELIZA (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ELIZA
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:ELIZA
Other - Middle Name:
Other - Last Name:CROCKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:109 HOMESTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:CROSSETT
Mailing Address - State:AR
Mailing Address - Zip Code:71635-5027
Mailing Address - Country:US
Mailing Address - Phone:318-557-7890
Mailing Address - Fax:
Practice Address - Street 1:168 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-4820
Practice Address - Country:US
Practice Address - Phone:870-367-4333
Practice Address - Fax:870-367-0140
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP9151235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist