Provider Demographics
NPI:1174887053
Name:WOOTEN, ELIZABETH PARKS (AUD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:PARKS
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:JOYCE
Other - Last Name:PARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:1105 CENTRAL EXPY N
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6103
Mailing Address - Country:US
Mailing Address - Phone:972-984-1050
Mailing Address - Fax:
Practice Address - Street 1:1105 CENTRAL EXPY N
Practice Address - Street 2:SUITE 210
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6103
Practice Address - Country:US
Practice Address - Phone:972-984-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80390231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist