Individual
LARISSA ANN STREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
700 GLASGOW ST, CAMBRIDGE, MD 21613-1738
(410) 228-4747
Mailing address
26601 QUANTICO CREEK RD, HEBRON, MD 21830-2183
(845) 389-3942
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
06716
MD
Other
Enumeration date
11/06/2018
Last updated
11/06/2018
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