Provider Demographics
NPI:1497907661
Name:LAMBERT, CLARISSA LIZETTE (CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:CLARISSA
Middle Name:LIZETTE
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6710 FARTHINGTON CIR APT 3E
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-2982
Mailing Address - Country:US
Mailing Address - Phone:914-330-5134
Mailing Address - Fax:
Practice Address - Street 1:9611 BROOKDALE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-8719
Practice Address - Country:US
Practice Address - Phone:704-807-5699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-19
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018435-1235Z00000X
NC10044235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist