Healthcare Provider Details

I. General information

NPI: 1528746047
Provider Name (Legal Business Name): ELIZABETH ANNE WYER M.ED. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5033 PORTSMOUTH RD
FAIRFAX VA
22032-2227
US

IV. Provider business mailing address

5033 PORTSMOUTH RD
FAIRFAX VA
22032-2227
US

V. Phone/Fax

Practice location:
  • Phone: 630-724-7319
  • Fax:
Mailing address:
  • Phone: 630-724-7319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202011825
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: