Healthcare Provider Details

I. General information

NPI: 1275834772
Provider Name (Legal Business Name): ELIZABETH M HOWARD SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2010
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 SAVANNA DR
CHAMPAIGN IL
61822-3608
US

IV. Provider business mailing address

2205 SAVANNA DR
CHAMPAIGN IL
61822-3608
US

V. Phone/Fax

Practice location:
  • Phone: 217-848-2781
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number146.008893
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number146.008893
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.008893
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: