Provider Demographics
NPI:1164991287
Name:EASTER, CARISSA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CARISSA
Middle Name:
Last Name:EASTER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9533 LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2407
Mailing Address - Country:US
Mailing Address - Phone:443-904-3176
Mailing Address - Fax:
Practice Address - Street 1:4691 TEN OAKS RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:MD
Practice Address - Zip Code:21036-1126
Practice Address - Country:US
Practice Address - Phone:410-313-1571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05025235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist