Provider Demographics
NPI:1275874992
Name:NATION, CARISSA NICOLE
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:NICOLE
Last Name:NATION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5945 BROCKTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-1800
Mailing Address - Country:US
Mailing Address - Phone:951-779-1966
Mailing Address - Fax:951-779-1933
Practice Address - Street 1:5945 BROCKTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-1800
Practice Address - Country:US
Practice Address - Phone:951-779-1966
Practice Address - Fax:951-779-1933
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASPA20332355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant