Healthcare Provider Details

I. General information

NPI: 1639751829
Provider Name (Legal Business Name): SARAH ANDERSON LARSEN MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2023 LAKE AVE
KNOXVILLE TN
37916-2903
US

IV. Provider business mailing address

11020 CHRISTCHURCH WAY APT 108
KNOXVILLE TN
37932-3460
US

V. Phone/Fax

Practice location:
  • Phone: 865-974-6702
  • Fax:
Mailing address:
  • Phone: 423-557-7674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: