Provider Demographics
NPI:1548848708
Name:PERFITT, ELIZABETH LAVELLA (MS, SLP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LAVELLA
Last Name:PERFITT
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:LIBBY
Other - Middle Name:
Other - Last Name:LAVELLA-PERFITT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, SLP
Mailing Address - Street 1:3304 SAVAGE AVE
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-1230
Mailing Address - Country:US
Mailing Address - Phone:213-265-5205
Mailing Address - Fax:
Practice Address - Street 1:NE 65TH AVENUE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-9721
Practice Address - Country:US
Practice Address - Phone:503-946-6907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist