Provider Demographics
NPI:1164611968
Name:PREFONTAINE, CLAIRE ELAINE (SPEECH THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:CLAIRE
Middle Name:ELAINE
Last Name:PREFONTAINE
Suffix:
Gender:F
Credentials:SPEECH THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2654 E BELLERIVE DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-4127
Mailing Address - Country:US
Mailing Address - Phone:480-883-0750
Mailing Address - Fax:
Practice Address - Street 1:2654 E BELLERIVE DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-4127
Practice Address - Country:US
Practice Address - Phone:480-883-0750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3201840235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist