Provider Demographics
NPI:1609357227
Name:STAVINOHA, ELIZABETH S (AUD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:S
Last Name:STAVINOHA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 E BANDERA RD STE 201
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2851
Mailing Address - Country:US
Mailing Address - Phone:830-331-9886
Mailing Address - Fax:
Practice Address - Street 1:124 E BANDERA RD STE 201
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2851
Practice Address - Country:US
Practice Address - Phone:830-331-9886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80974231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist