Provider Demographics
NPI:1578894846
Name:E. CHERYL FLETCHER SPEECH PATHOLOGY & ASSOCIATES
Entity Type:Organization
Organization Name:E. CHERYL FLETCHER SPEECH PATHOLOGY & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELISABETH
Authorized Official - Middle Name:CHERYL
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MACCC
Authorized Official - Phone:805-484-1671
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 3002252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ83857ZOtherBLUE OF CALIFORNIA