Individual
ELIZABETH ICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
112 HEATHERVIEW DR, EAST PEORIA, IL 61611-4889
(309) 360-0707
Mailing address
610 E WALNUT ST, BLOOMINGTON, IL 61701-3242
(309) 363-8599
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146011415
IL
Other
Enumeration date
01/23/2013
Last updated
01/23/2013
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