MEDICARE: MS. ELIZABETH S ANDERSON 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	1138	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528177797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH S ANDERSON MS CCC SLP

Provider Business Mailing Address
First Line	:	4699 PINE ST STE 103
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68106-2519
Country	:	US
Telephone Number	:	402-968-3263
Fax Number	:

Provider Business Practice Location Address
First Line	:	3516 N 163RD PLZ
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68116-2106
Country	:	US
Telephone Number	:	402-968-3263
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	09/17/2020

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