Provider Demographics
NPI:1710493424
Name:LAROSE, ALLYSSA SARAH JEAN (MS CF-SLP)
Entity Type:Individual
Prefix:
First Name:ALLYSSA
Middle Name:SARAH JEAN
Last Name:LAROSE
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4312 CHICAGO ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2217
Mailing Address - Country:US
Mailing Address - Phone:402-830-0415
Mailing Address - Fax:
Practice Address - Street 1:6901 BURT ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-2643
Practice Address - Country:US
Practice Address - Phone:402-557-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist