Individual
LARRESA KEYONNA PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.,CCC-SLP
Contact information
Practice address
2417 HIGHLAND DR, VIOLET, LA 70092-2962
(281) 662-5107
Mailing address
2417 HIGHLAND DR, VIOLET, LA 70092-2962
(281) 662-5107
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
8129
LA
Other
Enumeration date
01/25/2020
Last updated
01/25/2020
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