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General NPI Number Information
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NPI Number | 1932722337
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Entity Type | Individual
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Provider Name | MARISSA DEDDENS LARKIN M.S. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 05/20/2020
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Last Update Date | 02/17/2023
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Provider Practice Location Address
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Address Line | 126 S MAIN ST STE 2A
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City | DAVIDSON
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State | NC
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Zip | 28036-8096
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Country | US
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Telephone | 704-488-1245
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Fax |
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Provider Business Mailing Address
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Address Line | 2336 BARRY ST APT B
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City | CHARLOTTE
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State | NC
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Zip | 28205-2306
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Country | US
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Telephone | 704-488-1245
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 13125
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License Number State | NC
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