Provider Demographics
NPI:1164923058
Name:SLETTO, LARISSA ANN (CPO/LPO)
Entity Type:Individual
Prefix:
First Name:LARISSA
Middle Name:ANN
Last Name:SLETTO
Suffix:
Gender:F
Credentials:CPO/LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1S376 SUMMIT AVE
Mailing Address - Street 2:COURT E
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181
Mailing Address - Country:US
Mailing Address - Phone:630-424-0392
Mailing Address - Fax:
Practice Address - Street 1:20 EXECUTIVE CT STE 2
Practice Address - Street 2:
Practice Address - City:S BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-9543
Practice Address - Country:US
Practice Address - Phone:847-382-3222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL211000306224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist