Basic Information
Provider Information
NPI: 1316025752
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CALLAWAY
FirstName: ELIZABETH
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.S., CCC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1000 SCOTT PL
Address2:  
City: ANN ARBOR
State: MI
PostalCode: 481052585
CountryCode: US
TelephoneNumber: 7347697100
FaxNumber: 7347617304
Practice Location
Address1: 2215 FULLER RD
Address2:  
City: ANN ARBOR
State: MI
PostalCode: 481052335
CountryCode: US
TelephoneNumber: 7347697100
FaxNumber: 7347617304
Other Information
ProviderEnumerationDate: 11/02/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X  Y Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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