Individual
LARISSA HAYNES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP-CCC
Contact information
Practice address
635 S MAIN ST STE B, LEITCHFIELD, KY 42754-1056
(270) 287-0656
(270) 230-0328
Mailing address
635 S MAIN ST STE B, LEITCHFIELD, KY 42754-1056
(270) 287-0656
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
243574
KY
235Z00000X
Speech-Language Pathologist
5768
TN
Other
Enumeration date
11/27/2015
Last updated
06/13/2020
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