Provider Demographics
NPI:1295094837
Name:PREVALLET, BRITTANY (MA, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:BRITTANY
Middle Name:
Last Name:PREVALLET
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 1:1715 LOS LAGOS DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-6648
Mailing Address - Country:US
Mailing Address - Phone:573-768-1752
Mailing Address - Fax:
Practice Address - Street 1:3576 KEARSAGE DR
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86406-9115
Practice Address - Country:US
Practice Address - Phone:928-453-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP6954235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist