MEDICARE: MRS. ELIZABETH ROSE RAJ M.A., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	2004021605	MO

General Provider Information

NPI Number	:	1104855741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH ROSE RAJ M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	3488 JEFFCO BLVD
Second Line	:
City	:	ARNOLD
State	:	MO
Zip	:	63010-6015
Country	:	US
Telephone Number	:	636-464-5439
Fax Number	:	636-464-5438

Provider Business Practice Location Address
First Line	:	3488 JEFFCO BLVD
Second Line	:
City	:	ARNOLD
State	:	MO
Zip	:	63010-6015
Country	:	US
Telephone Number	:	636-464-5439
Fax Number	:	636-464-5438

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	03/01/2016

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