MEDICARE: ELIZABETH A. FAUSONE 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
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1073845483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH A. FAUSONE MS,CCC,SLP

Provider Business Mailing Address
First Line	:	2050 BRETON RD SE STE 107
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-5547
Country	:	US
Telephone Number	:	616-822-6272
Fax Number	:	616-226-5543

Provider Business Practice Location Address
First Line	:	2050 BRETON RD SE STE 107
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-5547
Country	:	US
Telephone Number	:	616-432-9059
Fax Number	:	616-226-5543

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2010
Last Update Date	:	08/15/2023

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