Provider Demographics
NPI:1932356383
Name:EINWECK, ELIZABETH ANN (BC HIS)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:EINWECK
Suffix:
Gender:F
Credentials:BC HIS
Other - Prefix:MRS
Other - First Name:BETTY
Other - Middle Name:ANN
Other - Last Name:EINWECK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BC HIS
Mailing Address - Street 1:8800 SE SUNNYSIDE RD STE 300N
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5703
Mailing Address - Country:US
Mailing Address - Phone:281-286-2999
Mailing Address - Fax:512-607-4893
Practice Address - Street 1:422 S 8TH STREET
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-4150
Practice Address - Country:US
Practice Address - Phone:217-228-0542
Practice Address - Fax:217-228-0547
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL535237700000X
MO590237700000X
MO237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1912922733Medicaid