Individual
ELIZABETH PETRISSANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
1930 E SOUTHERN AVE, TEMPE, AZ 85282-7518
(480) 456-0719
Mailing address
7217 N 25TH DR, PHOENIX, AZ 85051-6703
(602) 614-2255
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP6117
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
404138
—
AZ
Enumeration date
02/10/2009
Last updated
04/06/2011
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