Provider Demographics
NPI:1811143506
Name:PANOZZO, LARRY LUKE JR (CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:LUKE
Last Name:PANOZZO
Suffix:JR
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18500 BELLAGIO CIR
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-4459
Mailing Address - Country:US
Mailing Address - Phone:708-533-1080
Mailing Address - Fax:
Practice Address - Street 1:2203 PEMBRIDGE LN
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-7731
Practice Address - Country:US
Practice Address - Phone:815-409-8301
Practice Address - Fax:815-267-8505
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL12125459235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist