MEDICARE: ELIZABETH HANNAH CREP

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	222Q00000X	Developmental Therapist
2	2355S0801X	Speech-Language Assistant	SI3949	FL
3	252Y00000X	Early Intervention Provider Agency
4	235Z00000X	Speech-Language Pathologist	SA21208	FL

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	:	1679138648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH HANNAH CREP

Provider Business Mailing Address
First Line	:	6237 SW 13TH ST
Second Line	:
City	:	WEST MIAMI
State	:	FL
Zip	:	33144-5603
Country	:	US
Telephone Number	:	305-215-1770
Fax Number	:

Provider Business Practice Location Address
First Line	:	6237 SW 13TH ST
Second Line	:
City	:	WEST MIAMI
State	:	FL
Zip	:	33144-5603
Country	:	US
Telephone Number	:	305-215-1770
Fax Number	:

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

Provider Enumeration Date	:	05/06/2019
Last Update Date	:	03/01/2023

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