Provider Demographics
NPI:1881124386
Name:EZZO, ELIZABETH DOMBROWSKI
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DOMBROWSKI
Last Name:EZZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 VERDAE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-4021
Mailing Address - Country:US
Mailing Address - Phone:864-520-8910
Mailing Address - Fax:864-520-8912
Practice Address - Street 1:28 JIMMY DOOLITTLE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2622
Practice Address - Country:US
Practice Address - Phone:864-679-8606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-16
Last Update Date:2017-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6245235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist