Provider Demographics
NPI:1053978056
Name:DORNBIER, ELISE (AUD)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:DORNBIER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:
Other - Last Name:WAGENER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12499 UNIVERSITY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8288
Mailing Address - Country:US
Mailing Address - Phone:515-418-9960
Mailing Address - Fax:
Practice Address - Street 1:12499 UNIVERSITY AVE STE 200
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8288
Practice Address - Country:US
Practice Address - Phone:515-418-9960
Practice Address - Fax:515-418-9107
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist