Provider Demographics
NPI:1699928663
Name:CHASE, LARA SUZANNE (B-K LICENSE)
Entity type:Individual
Prefix:MRS
First Name:LARA
Middle Name:SUZANNE
Last Name:CHASE
Suffix:
Gender:F
Credentials:B-K LICENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7829 PERCUSSION DR
Mailing Address - Street 2:PREEMIES & ASSOCIATES, LLC
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-3611
Mailing Address - Country:US
Mailing Address - Phone:919-363-7585
Mailing Address - Fax:919-303-3939
Practice Address - Street 1:7829 PERCUSSION DR
Practice Address - Street 2:PREEMIES & ASSOCIATES, LLC
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27539-3611
Practice Address - Country:US
Practice Address - Phone:919-363-7585
Practice Address - Fax:919-303-3939
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
252Y00000X
NC8700014222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist