Provider Demographics
NPI:1760148126
Name:HOOD, LARA NICOLE (MS CCC- SLP)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:NICOLE
Last Name:HOOD
Suffix:
Gender:F
Credentials:MS 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:PO BOX 810
Mailing Address - Street 2:
Mailing Address - City:HALLSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75650-0810
Mailing Address - Country:US
Mailing Address - Phone:903-668-5990
Mailing Address - Fax:903-668-5991
Practice Address - Street 1:311 WILLOW ST
Practice Address - Street 2:
Practice Address - City:HALLSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75650
Practice Address - Country:US
Practice Address - Phone:903-668-5990
Practice Address - Fax:903-668-5991
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102079235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist