MEDICARE: MS. ELIZABETH S MORA 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
1	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
2	235Z00000X	Speech-Language Pathologist	SP6895	OH

General Provider Information

NPI Number	:	1518231364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH S MORA M.A., CCC SLP

Provider Business Mailing Address
First Line	:	176 E JEFFREY PL
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-1704
Country	:	US
Telephone Number	:	614-285-8539
Fax Number	:

Provider Business Practice Location Address
First Line	:	176 E JEFFREY PL
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-1704
Country	:	US
Telephone Number	:	614-285-8539
Fax Number	:

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

Provider Enumeration Date	:	02/25/2012
Last Update Date	:	04/07/2025

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