Provider Demographics
NPI:1366874984
Name:GORMAN, ELIZABETH S (SLP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:S
Last Name:GORMAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4530 BELTWAY DR
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3707
Mailing Address - Country:US
Mailing Address - Phone:214-646-1449
Mailing Address - Fax:214-516-7979
Practice Address - Street 1:4530 BELTWAY DR
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3707
Practice Address - Country:US
Practice Address - Phone:214-646-1449
Practice Address - Fax:214-516-7979
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101968235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist