Provider Demographics
NPI:1447555651
Name:BASS, ELIZABETH NICOLE (MS, SLP/CCC)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:NICOLE
Last Name:BASS
Suffix:
Gender:F
Credentials:MS, SLP/CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 BROWNELL RD
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71295-6308
Mailing Address - Country:US
Mailing Address - Phone:318-535-8385
Mailing Address - Fax:
Practice Address - Street 1:514 BROWNELL RD
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-6308
Practice Address - Country:US
Practice Address - Phone:318-535-8385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-19
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6047235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist