Active NPI
Carissa Stuck
- Speech-Language Pathologist
- Orange, CA
National Provider Identifier
1720486483
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- RPE 9554
- Practice address
- 3111 N Tustin St
#100
Orange, CA 92865-1750 - Phone
- (855) 295-3276
- Fax
- (818) 241-6853
- NPI assigned
- Dec 11, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | RPE 9554 | CA | Primary |
Addresses
Primary practice location
3111 N Tustin St
#100
Orange, CA 92865-1750
Mailing address
505 N Brand Blvd
#1000
Glendale, CA 91203-1906
Phone (818) 241-6780
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RPE 9554 | Other | CA | SLP |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPE 9554 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1418256000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1418256000000",
"number": "1720486483",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "505 N BRAND BLVD",
"address_2": "#1000",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912031906",
"telephone_number": "818-241-6780",
"fax_number": "818-241-6853"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3111 N TUSTIN ST",
"address_2": "#100",
"city": "ORANGE",
"state": "CA",
"postal_code": "928651750",
"telephone_number": "855-295-3276",
"fax_number": "818-241-6853"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STUCK",
"first_name": "CARISSA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-12-11",
"last_updated": "2014-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "RPE 9554",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SLP",
"identifier": "RPE 9554",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Orange, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.