Provider Demographics
NPI:1205977923
Name:VANDAL, ELIZABETH L (SLP)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:L
Last Name:VANDAL
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 1:215 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-3924
Mailing Address - Country:US
Mailing Address - Phone:701-857-4410
Mailing Address - Fax:
Practice Address - Street 1:860 JEFFERSON DR
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:ND
Practice Address - Zip Code:58540-7400
Practice Address - Country:US
Practice Address - Phone:701-463-2213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND276235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND50392Medicaid