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NPI Code Detail

MEDICARE: ELIZABETH G TRAVIS M.A., CCC-SLP

MEDICARE: ELIZABETH G TRAVIS M.A., 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 Pathologist2202003593VA

General Provider Information

NPI Number : 1437282779
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH G TRAVIS M.A., CCC-SLP
Provider Business Mailing Address
First Line : 11103 BREWER CT
Second Line :
City : HENRICO
State : VA
Zip : 23233-2275
Country : US
Telephone Number : 804-740-2407
Fax Number :
Provider Business Practice Location Address
First Line : 1600 WESTBROOK AVE
Second Line :
City : RICHMOND
State : VA
Zip : 23227-3337
Country : US
Telephone Number : 804-264-6216
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2007
Last Update Date : 01/25/2012

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