Individual
LARISSA PEIZER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.Z., CCC-SLP
Contact information
Practice address
5200 SW MACADAM AVE, PORTLAND, OR 97239-6103
(503) 224-1998
Mailing address
5200 SW MACADAM AVE, PORTLAND, OR 97239-6103
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
16096
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14131465
AMERICAN SPEECH AND HEARING ASSOCIATION
—
01
—
16096
BOARD OF EXAMINERS FOR SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY
OR
Enumeration date
08/31/2017
Last updated
08/31/2017
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