MEDICARE: ELIZABETH UDUEHI

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	110676	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000000	OTHER		NOT APPLICABLE

General Provider Information

NPI Number	:	1306494281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH UDUEHI

Provider Business Mailing Address
First Line	:	605 E BROAD ST
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-1794
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	605 E BROAD ST
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-1794
Country	:	US
Telephone Number	:	817-299-6300
Fax Number	:

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

Provider Enumeration Date	:	09/03/2019
Last Update Date	:	12/11/2025

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Directions to “ ELIZABETH UDUEHI ” Practice Location

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