Healthcare Provider Details

I. General information

NPI: 1487563938
Provider Name (Legal Business Name): IAN AVERY LARSON CF-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 E MOUND ST
CIRCLEVILLE OH
43113-1821
US

IV. Provider business mailing address

424 E MOUND ST
CIRCLEVILLE OH
43113-1821
US

V. Phone/Fax

Practice location:
  • Phone: 740-474-7529
  • Fax: 740-474-7251
Mailing address:
  • Phone: 740-474-7529
  • Fax: 740-474-7251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberCOND.20263531-SP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: