1043943608 NPI number — ELIZABETH WILLIAMS SEIBERT SLP

Table of content: ELIZABETH WILLIAMS SEIBERT SLP (NPI 1043943608)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043943608 NPI number — ELIZABETH WILLIAMS SEIBERT SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEIBERT
Provider First Name:
ELIZABETH
Provider Middle Name:
WILLIAMS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILLIAMS
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
STREET
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043943608
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
921 W. BEACON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39350-3229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-650-0002
Provider Business Mailing Address Fax Number:
601-650-9902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2653 WEST OXFORD LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXFORD
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38655-5442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-715-3045
Provider Business Practice Location Address Fax Number:
662-715-3046
Provider Enumeration Date:
07/01/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SLP012117 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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