Doctor Name: | MISS LARISSA ANN FEDAK |
NPI Number: | 1235376997 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, CCC-SLP |
License Number: | 41YS00572200 |
Business Practice Address: | 7912 River Rd Apartment 902 North Bergen, NJ - 070476271 |
Business Phone Number: | 2012849136 |
Business Fax Number: | |
Mailing Address: | 7912 River Rd, Apartment 902 NORTH BERGEN |
State: | NJ |
Postal Code: | 070476271 |
Phone Number: | 2012849136 |
Fax Number: | |
NPI Enumeration Date: | 01/16/2009 |
NPI Last Update Date: | 01/16/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 41YS00572200 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NJ |
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 |