Individual
MRS. ELIZABETH ANN PETLEV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSCCCSLP
Contact information
Practice address
9291 GLADES RD, BOCA RATON, FL 33434-3959
(561) 955-5437
(561) 483-7044
Mailing address
11125 STONE CREEK ST, WELLINGTON, FL 33467-8335
(561) 784-1745
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA5629
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
886163300
—
FL
01
—
SA5629
STATE LICENCE
FL
Enumeration date
06/07/2007
Last updated
07/08/2007
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