Provider Demographics
NPI:1831379494
Name:STETZEL, ELIZABETH DIANE (MSCCC-SLP)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:DIANE
Last Name:STETZEL
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 EMORY VALLEY RD
Mailing Address - Street 2:#916
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6523
Mailing Address - Country:US
Mailing Address - Phone:886-522-8062
Mailing Address - Fax:
Practice Address - Street 1:790 EMORY VALLEY RD
Practice Address - Street 2:#916
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6523
Practice Address - Country:US
Practice Address - Phone:886-522-8062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-11
Last Update Date:2007-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3739235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist