Healthcare Provider Details

I. General information

NPI: 1275479818
Provider Name (Legal Business Name): ELIZABETH C AVILA CCC-SLP
Entity Type: Individual
Gender:
Sole Proprietor: Y

Provider Other Name: ELIZABETH COLLEEN MITCHELL CCC-SLP

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 W VICTOR CT
VISALIA CA
93277-8815
US

IV. Provider business mailing address

4940 W VICTOR CT
VISALIA CA
93277-8815
US

V. Phone/Fax

Practice location:
  • Phone: 559-802-0772
  • Fax:
Mailing address:
  • Phone: 559-802-0772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: