MEDICARE: MRS. ELIZABETH DELLER M.A. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	17723	CA

General Provider Information

NPI Number	:	1265715882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH DELLER M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	4420 E MIRALOMA AVE STE A
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92807-1838
Country	:	US
Telephone Number	:	714-660-9300
Fax Number	:	844-675-3501

Provider Business Practice Location Address
First Line	:	4420 E MIRALOMA AVE STE A
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92807-1838
Country	:	US
Telephone Number	:	714-696-6321
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2011
Last Update Date	:	03/10/2020

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Directions to “ MRS. ELIZABETH DELLER M.A. CCC-SLP” Practice Location

Language	Start Address	Practice Location

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