Larissa Niessen, MS CCC-SLP/L

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

23092 Issued in CA

Practice address

1401 W Valencia Dr
Fullerton, CA 92833-3998

Phone

(714) 447-7745

NPI assigned

Sep 11, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1599782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599782400000",
    "number": "1780299180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 S BREA BLVD UNIT 16",
            "city": "BREA",
            "state": "CA",
            "postal_code": "928216810",
            "telephone_number": "805-705-5088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 W VALENCIA DR",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928333998",
            "telephone_number": "714-447-7745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIESSEN",
        "first_name": "LARISSA",
        "credential": "MS CCC-SLP/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-11",
        "last_updated": "2020-09-11",
        "certification_date": "2020-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "23092",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Fullerton, CA
• Providers in Fullerton, CA by specialty
• Speech-Language Pathologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.