MEDICARE: ALISSA VARLAMOVA 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
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1104448455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISSA VARLAMOVA CCC-SLP

Provider Business Mailing Address
First Line	:	2626 S RAINBOW BLVD STE 103
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5190
Country	:	US
Telephone Number	:	310-243-6763
Fax Number	:

Provider Business Practice Location Address
First Line	:	2626 S RAINBOW BLVD STE 103
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5190
Country	:	US
Telephone Number	:	310-243-6763
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2020
Last Update Date	:	12/20/2023

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Directions to “ ALISSA VARLAMOVA CCC-SLP” Practice Location

Language	Start Address	Practice Location

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