Provider Demographics
NPI:1225195183
Name:FLETCHER, ELISABETH CHERYL (MA CCC)
Entity Type:Individual
Prefix:MS
First Name:ELISABETH
Middle Name:CHERYL
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:MA CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 VALLEY VISTA DR
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1725
Mailing Address - Country:US
Mailing Address - Phone:805-484-1671
Mailing Address - Fax:805-987-0667
Practice Address - Street 1:150 VALLEY VISTA DR
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-1725
Practice Address - Country:US
Practice Address - Phone:805-484-1671
Practice Address - Fax:805-987-0667
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 3002235Z00000X
1-11-8110103K00000X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ83857ZOtherBLUE SHIELD