Healthcare Provider Details

I. General information

NPI: 1578894846
Provider Name (Legal Business Name): E. CHERYL FLETCHER SPEECH PATHOLOGY & ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2010
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 VALLEY VISTA DR
CAMARILLO CA
93010-1725
US

IV. Provider business mailing address

150 VALLEY VISTA DR
CAMARILLO CA
93010-1725
US

V. Phone/Fax

Practice location:
  • Phone: 805-484-1671
  • Fax: 805-987-0667
Mailing address:
  • Phone: 805-484-1671
  • Fax: 805-987-0667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberSP 3002
License Number StateCA

VIII. Authorized Official

Name: MS. ELISABETH CHERYL FLETCHER
Title or Position: OWNER
Credential: MACCC
Phone: 805-484-1671