Provider Demographics
NPI:1255764551
Name:LEVATTER, THEODORE (MA, CCC)
Entity type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:
Last Name:LEVATTER
Suffix:
Gender:M
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 1:6716 CLYBOURN AVE
Mailing Address - Street 2:#238
Mailing Address - City:N HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-2264
Mailing Address - Country:US
Mailing Address - Phone:818-308-7984
Mailing Address - Fax:818-308-7984
Practice Address - Street 1:55 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:SIERRA MADRE
Practice Address - State:CA
Practice Address - Zip Code:91024-1847
Practice Address - Country:US
Practice Address - Phone:626-757-2817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-10
Last Update Date:2013-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP5451235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist