Healthcare Provider Details

I. General information

NPI: 1053094060
Provider Name (Legal Business Name): LARISA KALINOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 QUARTERPATH RD STE 5A
WILLIAMSBURG VA
23185-6544
US

IV. Provider business mailing address

46-050 KONANE PL APT 3721
KANEOHE HI
96744-6123
US

V. Phone/Fax

Practice location:
  • Phone: 757-206-2805
  • Fax:
Mailing address:
  • Phone: 216-470-8692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: