Provider Demographics
NPI:1811262603
Name:CENTER, LARRY EISENMAN (MS CCC-A)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:EISENMAN
Last Name:CENTER
Suffix:
Gender:M
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1838 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3941
Mailing Address - Country:US
Mailing Address - Phone:901-726-0044
Mailing Address - Fax:
Practice Address - Street 1:1838 UNION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3941
Practice Address - Country:US
Practice Address - Phone:901-726-0044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN123231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist