Provider Demographics
NPI:1932722337
Name:LARKIN, MARISSA DEDDENS (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:DEDDENS
Last Name:LARKIN
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 1:2336 BARRY ST APT B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-2306
Mailing Address - Country:US
Mailing Address - Phone:704-488-1245
Mailing Address - Fax:
Practice Address - Street 1:126 S MAIN ST STE 2A
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-8096
Practice Address - Country:US
Practice Address - Phone:704-488-1245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13125235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist