Provider Demographics
NPI:1255625224
Name:LAVAGETTO, SHEILA ANN (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:ANN
Last Name:LAVAGETTO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2586 BUTHMANN AVE
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-2165
Mailing Address - Country:US
Mailing Address - Phone:209-832-2273
Mailing Address - Fax:209-832-0743
Practice Address - Street 1:2586 BUTHMANN AVE
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-2165
Practice Address - Country:US
Practice Address - Phone:209-832-2273
Practice Address - Fax:209-832-0743
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18492235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist