Provider Demographics
NPI:1407504244
Name:SEGURA, ELIZABETH (SLPA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:SEGURA
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4820 REEDER AVE
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033-8036
Mailing Address - Country:US
Mailing Address - Phone:805-814-5243
Mailing Address - Fax:
Practice Address - Street 1:4675 VIA LOS SANTOS
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-1346
Practice Address - Country:US
Practice Address - Phone:805-637-5272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASPA70362355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASPA7036Medicaid