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NPI Code Detail

MEDICARE: KRISTIN LEE LARSON M.S., CCC-SLP

MEDICARE: KRISTIN LEE LARSON M.S., 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 Pathologist138626KY
2235Z00000XSpeech-Language PathologistKY-3875KY

General Provider Information

NPI Number : 1215276894
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIN LEE LARSON M.S., CCC-SLP
Provider Business Mailing Address
First Line : 209 BLISS AVE
Second Line :
City : LOUISVILLE
State : KY
Zip : 40243-1005
Country : US
Telephone Number : 502-821-5747
Fax Number :
Provider Business Practice Location Address
First Line : 100 W RAMSEY ST
Second Line :
City : DAWSON SPRINGS
State : KY
Zip : 42408-1739
Country : US
Telephone Number : 270-797-8132
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2013
Last Update Date : 04/29/2020

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Directions to “ KRISTIN LEE LARSON M.S., CCC-SLP” Practice Location

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