Healthcare Provider Details

I. General information

NPI: 1306235742
Provider Name (Legal Business Name): ELIZABETH ANN CARRELL CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2015
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 LONG BEACH BLVD STE 700
LONG BEACH CA
90807-2000
US

IV. Provider business mailing address

NORTHERN CALIFORNIA CHILDREN'S THERAPY CENTER
WOODLLAND CA
95695
US

V. Phone/Fax

Practice location:
  • Phone: 818-894-2273
  • Fax: 818-357-2505
Mailing address:
  • Phone: 530-668-1010
  • Fax: 530-668-9799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP-5236
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number15674
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: