Provider Demographics
NPI:1174888432
Name:LERMA, MARISSA
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:LERMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 PERKINS DR
Mailing Address - Street 2:STE B
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3248
Mailing Address - Country:US
Mailing Address - Phone:575-652-3155
Mailing Address - Fax:575-652-4104
Practice Address - Street 1:120 WYATT DR.
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005
Practice Address - Country:US
Practice Address - Phone:575-652-3155
Practice Address - Fax:575-652-4104
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-5140235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist