Healthcare Provider Details

I. General information

NPI: 1609180793
Provider Name (Legal Business Name): ELIZABETH J LIAN M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2010
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10045 BALTIMORE NATIONAL PIKE STE A7
ELLICOTT CITY MD
21042-3673
US

IV. Provider business mailing address

10045 BALTIMORE NATIONAL PIKE STE A7
ELLICOTT CITY MD
21042-3673
US

V. Phone/Fax

Practice location:
  • Phone: 904-303-0183
  • Fax:
Mailing address:
  • Phone: 904-303-0183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2017016066
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number10137
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP30832
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 11240
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: