Individual
MRS. ELIZABETH SHIELDS FAGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
4012 PARK RD, SUITE 200, CHARLOTTE, NC 28209-2377
(704) 332-4824
Mailing address
2420 E 5TH ST, CHARLOTTE, NC 28204-4339
(704) 332-4834
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
6845
NC
Other
Enumeration date
10/25/2006
Last updated
03/26/2012
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