Provider Demographics
NPI:1174886089
Name:LILES, ELIZABETH ANN (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:LILES
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5110 S. YALE AVE.
Mailing Address - Street 2:THERAPY 4 KIDS
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135
Mailing Address - Country:US
Mailing Address - Phone:918-492-2386
Mailing Address - Fax:918-645-8686
Practice Address - Street 1:4219 BEE CREEK ROAD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-7873
Practice Address - Country:US
Practice Address - Phone:512-533-3021
Practice Address - Fax:737-931-3000
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4175235Z00000X
OK263107912235Z00000X
TX115414235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115414Medicaid
OK200203810AMedicaid