Basic Information
| Provider Information | |||||||||
| NPI: | 1174887053 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOOTEN | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | PARKS | ||||||||
| NamePrefix: | |||||||||
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| Credential: | AU.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PARKS | ||||||||
| OtherFirstName: | ELIZABETH | ||||||||
| OtherMiddleName: | JOYCE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | AU.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1105 CENTRAL EXPY N | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | ALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750136103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729841050 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1105 CENTRAL EXPY N | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | ALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750136103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729841050 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2012 | ||||||||
| LastUpdateDate: | 09/30/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 80390 | TX | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.