Healthcare Provider Details

I. General information

NPI: 1073945341
Provider Name (Legal Business Name): REBECCA C LARSEN AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 01/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 160 M.P. 394.3
KAYENTA AZ
86033
US

IV. Provider business mailing address

PO BOX 3446
KAYENTA AZ
86033-3446
US

V. Phone/Fax

Practice location:
  • Phone: 928-697-5134
  • Fax: 928-697-4030
Mailing address:
  • Phone: 928-697-5134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License NumberDA8401
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: