Provider Demographics
NPI:1164078374
Name:BELL, LARISSA LEE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LARISSA
Middle Name:LEE
Last Name:BELL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:LARISSA
Other - Middle Name:LEE
Other - Last Name:KAMINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:16782 VON KARMAN AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-2417
Mailing Address - Country:US
Mailing Address - Phone:714-351-9250
Mailing Address - Fax:
Practice Address - Street 1:16782 VON KARMAN AVE STE 11
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-2417
Practice Address - Country:US
Practice Address - Phone:714-351-9250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17876235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist