Provider Demographics
NPI:1215219761
Name:CRISLER, LARA ANSLEY (SLP)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:ANSLEY
Last Name:CRISLER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 49545
Mailing Address - Street 2:1175 OGLETHORPE AVE., STE. B
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30604-9545
Mailing Address - Country:US
Mailing Address - Phone:706-353-3575
Mailing Address - Fax:706-353-1606
Practice Address - Street 1:1175 OGLETHORPE AVE
Practice Address - Street 2:STE. B
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2129
Practice Address - Country:US
Practice Address - Phone:706-353-3575
Practice Address - Fax:706-353-1606
Is Sole Proprietor?:No
Enumeration Date:2011-09-11
Last Update Date:2011-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007027235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist