Provider Demographics
NPI:1982884888
Name:LARRANCE, CONNIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:LARRANCE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 YALE WAY
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2078
Mailing Address - Country:US
Mailing Address - Phone:530-342-5686
Mailing Address - Fax:
Practice Address - Street 1:16 YALE WAY
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2078
Practice Address - Country:US
Practice Address - Phone:530-342-5686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8845235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist