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NPI Code Detail

MEDICARE: MS. KRISTIN ANN LARSEN MA, CCC-SLP

MEDICARE: MS. KRISTIN ANN LARSEN MA, CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist146.005459IL

General Provider Information

NPI Number : 1952419020
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KRISTIN ANN LARSEN MA, CCC-SLP
Provider Business Mailing Address
First Line : 675 N SAINT CLAIR ST STE 15-200
Second Line :
City : CHICAGO
State : IL
Zip : 60611-5967
Country : US
Telephone Number : 312-695-8182
Fax Number : 312-695-4303
Provider Business Practice Location Address
First Line : 675 N SAINT CLAIR ST STE 15-200
Second Line :
City : CHICAGO
State : IL
Zip : 60611-5967
Country : US
Telephone Number : 312-695-8182
Fax Number : 312-695-4303
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2006
Last Update Date : 03/31/2022

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