Provider Demographics
NPI:1902014707
Name:IMES, ELIZABETH TUPACZ (SLP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:TUPACZ
Last Name:IMES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-3322
Mailing Address - Country:US
Mailing Address - Phone:423-926-1075
Mailing Address - Fax:
Practice Address - Street 1:4850 E ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-3098
Practice Address - Country:US
Practice Address - Phone:423-787-6983
Practice Address - Fax:423-787-6768
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001709235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist