MEDICARE: ELIZABETH CAROL REDFORD CF-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	2204000658	VA

General Provider Information

NPI Number	:	1538834890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH CAROL REDFORD CF-SLP

Provider Business Mailing Address
First Line	:	3445 HOWARD RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-1429
Country	:	US
Telephone Number	:	434-294-0059
Fax Number	:

Provider Business Practice Location Address
First Line	:	9450 ATLEE STATION RD
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-2600
Country	:	US
Telephone Number	:	804-723-2160
Fax Number	:

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

Provider Enumeration Date	:	08/10/2021
Last Update Date	:	08/10/2021

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