Provider Demographics
NPI:1386015253
Name:ESPINOZA, CARISSA
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:
Last Name:ESPINOZA
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 1:2435 E SOUTHERN AVE
Mailing Address - Street 2:#7
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7628
Mailing Address - Country:US
Mailing Address - Phone:480-345-2012
Mailing Address - Fax:
Practice Address - Street 1:2435 E SOUTHERN AVE
Practice Address - Street 2:#7
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7628
Practice Address - Country:US
Practice Address - Phone:480-345-2012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA96782355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant