Healthcare Provider Details

I. General information

NPI: 1548187552
Provider Name (Legal Business Name): ABIGAYLE LARSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 GLENWOOD AVE STE LL
JOLIET IL
60435-5660
US

IV. Provider business mailing address

2201 GLENWOOD AVE STE LL
JOLIET IL
60435-5660
US

V. Phone/Fax

Practice location:
  • Phone: 815-531-3802
  • Fax: 815-725-1248
Mailing address:
  • Phone: 815-531-3802
  • Fax: 815-725-1248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147.012364
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: