Healthcare Provider Details

I. General information

NPI: 1760042907
Provider Name (Legal Business Name): ELIZABETH KUBITZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH BARNES

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 TANFIELD ST
WEST BLOOMFIELD MI
48324-3528
US

IV. Provider business mailing address

12686 CLYDE RD
FENTON MI
48430-4617
US

V. Phone/Fax

Practice location:
  • Phone: 248-599-1928
  • Fax:
Mailing address:
  • Phone: 248-534-3813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101007202
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: