Healthcare Provider Details

I. General information

NPI: 1740166719
Provider Name (Legal Business Name): ELIZABETH GRACE LIGHTLE M.S. CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3367 COUNTY ROAD 550
FRANKFORT OH
45628-9503
US

IV. Provider business mailing address

1284 ALMA OMEGA RD
WAVERLY OH
45690-9321
US

V. Phone/Fax

Practice location:
  • Phone: 740-998-4633
  • Fax:
Mailing address:
  • Phone: 740-648-9606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberCOND.20253245-SP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: