Provider Demographics
NPI:1518231364
Name:MORA, ELIZABETH S (MA, CCC SLP)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:S
Last Name:MORA
Suffix:
Gender:
Credentials:MA, CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 E JEFFREY PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1704
Mailing Address - Country:US
Mailing Address - Phone:614-285-8539
Mailing Address - Fax:
Practice Address - Street 1:176 E JEFFREY PL
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1704
Practice Address - Country:US
Practice Address - Phone:614-285-8539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-25
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
385HR2060X
OHSP6895235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child