Provider Demographics
NPI:1669466892
Name:MAZZEO, LARRY (AUD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:MAZZEO
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 TURKEY RUN
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-3889
Mailing Address - Country:US
Mailing Address - Phone:573-341-8409
Mailing Address - Fax:
Practice Address - Street 1:600 BLUES LAKE PKWY
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-8022
Practice Address - Country:US
Practice Address - Phone:573-364-5719
Practice Address - Fax:573-364-5719
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO117468231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist