Provider Demographics
NPI:1740964089
Name:STRUM, CARISSA JOY (SLP)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:JOY
Last Name:STRUM
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:693 LEESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-2828
Mailing Address - Country:US
Mailing Address - Phone:434-200-5750
Mailing Address - Fax:434-200-1294
Practice Address - Street 1:693 LEESVILLE RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2828
Practice Address - Country:US
Practice Address - Phone:434-200-5750
Practice Address - Fax:434-200-1294
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202011412235Z00000X
NC30003605235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist