MEDICARE: MRS. ELIZABETH ANN PURCELL SLP-A

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	2355S0801X	Speech-Language Assistant	SLPA6368	AZ

General Provider Information

NPI Number	:	1326379801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH ANN PURCELL SLP-A

Provider Business Mailing Address
First Line	:	12907 W GREENWAY RD
Second Line	:
City	:	EL MIRAGE
State	:	AZ
Zip	:	85335-9759
Country	:	US
Telephone Number	:	602-803-5633
Fax Number	:

Provider Business Practice Location Address
First Line	:	9514 W SPANISH MOSS LN
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85373-1742
Country	:	US
Telephone Number	:	602-803-5633
Fax Number	:

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

Provider Enumeration Date	:	01/22/2010
Last Update Date	:	01/22/2010

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