Provider Demographics
NPI:1639446578
Name:CAGLE, LARYSSA (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LARYSSA
Middle Name:
Last Name:CAGLE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 TREVISO GRAND CIR UNIT 101
Mailing Address - Street 2:
Mailing Address - City:NOKOMIS
Mailing Address - State:FL
Mailing Address - Zip Code:34275-3467
Mailing Address - Country:US
Mailing Address - Phone:303-913-6874
Mailing Address - Fax:
Practice Address - Street 1:700 TREVISO GRAND CIR UNIT 101
Practice Address - Street 2:
Practice Address - City:NOKOMIS
Practice Address - State:FL
Practice Address - Zip Code:34275-3467
Practice Address - Country:US
Practice Address - Phone:303-913-6874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12073136235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist