Provider Demographics
NPI:1588691885
Name:LEFEVRE, CECILY JOAN (PHD)
Entity type:Individual
Prefix:
First Name:CECILY
Middle Name:JOAN
Last Name:LEFEVRE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2173 TALBERT DR
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-7635
Mailing Address - Country:US
Mailing Address - Phone:530-592-5233
Mailing Address - Fax:530-892-9364
Practice Address - Street 1:572 RIO LINDO AVE. SUITE 202
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1851
Practice Address - Country:US
Practice Address - Phone:530-592-5233
Practice Address - Fax:530-892-9364
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU708231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0007080Medicaid
CAAU0007080OtherBLUE SHIELD OF CALIFORNIA
CAAU0007080OtherBLUE SHIELD OF CALIFORNIA
ZZZ94495ZMedicare ID - Type Unspecified