Individual
DR. LARISSA ANN FEDAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
EDD CCC-SLP BCBA-D
Contact information
Practice address
9500 ANNAPOLIS RD STE B2C2C3, LANHAM, MD 20706-2060
(301) 850-1148
Mailing address
4452 US HIGHWAY 421, PENNINGTON GAP, VA 24277-7972
(855) 832-6727
(772) 675-9100
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-11-8515
—
235Z00000X
Speech-Language Pathologist
018241
NY
235Z00000X
Speech-Language Pathologist
41YS00572200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-11-8515
BCBA-D
—
05
—
1235376997
—
NJ
Enumeration date
01/16/2009
Last updated
05/08/2025
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