Provider Demographics
NPI:1598091027
Name:LANZILLO, KARA KERNUS
Entity Type:Individual
Prefix:MRS
First Name:KARA
Middle Name:KERNUS
Last Name:LANZILLO
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 1:4560 PRINCESS ANNE RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-7905
Mailing Address - Country:US
Mailing Address - Phone:757-495-4211
Mailing Address - Fax:
Practice Address - Street 1:100 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-4529
Practice Address - Country:US
Practice Address - Phone:703-517-9115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-18
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004920235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist