Provider Demographics
NPI:1073866091
Name:LARA, VANESSA TIANNA (BA,SLPA)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:TIANNA
Last Name:LARA
Suffix:
Gender:F
Credentials:BA,SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 S OLD SPRINGS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1260
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:160 S OLD SPRINGS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-1260
Practice Address - Country:US
Practice Address - Phone:714-282-8852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASPA13142355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant