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NPI Code Detail

MEDICARE: CARISSA JENE LORANCE MS, CCC/SLP

MEDICARE: CARISSA JENE LORANCE MS, CCC/SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist108213TX

General Provider Information

NPI Number : 1104251057
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARISSA JENE LORANCE MS, CCC/SLP
Provider Business Mailing Address
First Line : PO BOX 844658
Second Line :
City : DALLAS
State : TX
Zip : 75284-4658
Country : US
Telephone Number : 254-724-2111
Fax Number :
Provider Business Practice Location Address
First Line : 900 SCOTT AND WHITE DR
Second Line :
City : COLLEGE STATION
State : TX
Zip : 77845-6419
Country : US
Telephone Number : 979-207-7400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2013
Last Update Date : 12/19/2025

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