Provider Demographics
NPI:1053809046
Name:LARROUDE, BEATRIZ ELENA (EDD, CCC-SLP)
Entity type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:ELENA
Last Name:LARROUDE
Suffix:
Gender:F
Credentials:EDD, CCC-SLP
Other - Prefix:
Other - First Name:BETTINA
Other - Middle Name:
Other - Last Name:LARROUDE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDD, CCC-SLP
Mailing Address - Street 1:3640 GRAND AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-2023
Mailing Address - Country:US
Mailing Address - Phone:510-986-1476
Mailing Address - Fax:
Practice Address - Street 1:3640 GRAND AVE STE 102
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2023
Practice Address - Country:US
Practice Address - Phone:510-986-1476
Practice Address - Fax:510-986-1476
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP9516235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist