Individual
ELIZABETH ANN SHORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MCD, CCC SLP
Contact information
Practice address
2209 W DETROIT ST, BROKEN ARROW, OK 74012-3628
(918) 615-6492
Mailing address
1709 W DALLAS ST, BROKEN ARROW, OK 74012-8340
(918) 430-4062
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3422
OK
235Z00000X
Speech-Language Pathologist
SP#2413
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
158836721
—
AR
Enumeration date
03/02/2007
Last updated
03/17/2022
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