Healthcare Provider Details

I. General information

NPI: 1336053735
Provider Name (Legal Business Name): ELIZABETH MAY RUSSELL SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH MAY GOLD

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 N GRANITE AVE
GRANITE FALLS WA
98252-8774
US

IV. Provider business mailing address

20227 77TH AVE NE UNIT J103
ARLINGTON WA
98223-4977
US

V. Phone/Fax

Practice location:
  • Phone: 360-691-7719
  • Fax:
Mailing address:
  • Phone: 509-393-2668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA.SP.61689500
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: