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NPI Code Detail

MEDICARE: ELIZABETH ANN SHORT MCD, CCC SLP

MEDICARE: ELIZABETH ANN SHORT MCD, 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 PathologistSP#2413AR
2235Z00000XSpeech-Language Pathologist3422OK

Other Identifiers

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

General Provider Information

NPI Number : 1750410288
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH ANN SHORT MCD, CCC SLP
Provider Business Mailing Address
First Line : 1709 W DALLAS ST
Second Line :
City : BROKEN ARROW
State : OK
Zip : 74012-8340
Country : US
Telephone Number : 918-430-4062
Fax Number :
Provider Business Practice Location Address
First Line : 2209 W DETROIT ST
Second Line :
City : BROKEN ARROW
State : OK
Zip : 74012-3628
Country : US
Telephone Number : 918-615-6492
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2007
Last Update Date : 03/17/2022

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