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NPI Code Detail

MEDICARE: L ELIZABETH CONWAY MS-CCC/SLP

MEDICARE: L ELIZABETH CONWAY MS-CCC/SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist13075TX

General Provider Information

NPI Number : 1073795472
Entity Type Code : Individual
Provider Name (Legal Business Name) : L ELIZABETH CONWAY MS-CCC/SLP
Provider Business Mailing Address
First Line : 3550 HULEN ST
Second Line : SUITE D
City : FORT WORTH
State : TX
Zip : 76107-6808
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3550 HULEN ST
Second Line : SUITE D
City : FORT WORTH
State : TX
Zip : 76107-6808
Country : US
Telephone Number : 817-377-2535
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2007
Last Update Date : 11/28/2007

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Directions to “ L ELIZABETH CONWAY MS-CCC/SLP” Practice Location

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