Doctor Name: | LARA MONICO |
NPI Number: | 1154573806 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.C.D. |
License Number: | S2757 |
Business Practice Address: | 2500 N State St Jackson, MS - 392164500 |
Business Phone Number: | 6018156057 |
Business Fax Number: | |
Mailing Address: | 2500 N State St, JACKSON |
State: | MS |
Postal Code: | 392164500 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 10/14/2008 |
NPI Last Update Date: | 10/14/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | S2757 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |