Individual
CARISSA STUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3111 N TUSTIN ST, #100, ORANGE, CA 92865-1750
(855) 295-3276
(818) 241-6853
Mailing address
505 N BRAND BLVD, #1000, GLENDALE, CA 91203-1906
(818) 241-6780
(818) 241-6853
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
RPE 9554
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RPE 9554
SLP
CA
Enumeration date
12/11/2014
Last updated
12/11/2014
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