Provider Demographics
NPI:1568155869
Name:NAVARRO, LARISSA R (AUD)
Entity Type:Individual
Prefix:
First Name:LARISSA
Middle Name:R
Last Name:NAVARRO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 COUNTY ROAD 304E
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:TX
Mailing Address - Zip Code:79360
Mailing Address - Country:US
Mailing Address - Phone:956-207-0914
Mailing Address - Fax:
Practice Address - Street 1:540 W 5TH ST STE 405
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5018
Practice Address - Country:US
Practice Address - Phone:432-640-6365
Practice Address - Fax:432-640-4759
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81544231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist