MEDICARE: NATASHA LARSSON

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
1	235Z00000X	Speech-Language Pathologist	11339	CA

General Provider Information

NPI Number	:	1730629031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATASHA LARSSON

Provider Business Mailing Address
First Line	:	3225 RIDA ST
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-2033
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3225 RIDA ST
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-2033
Country	:	US
Telephone Number	:	626-552-1267
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2017
Last Update Date	:	03/06/2017

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Directions to “ NATASHA LARSSON ” Practice Location

Language	Start Address	Practice Location

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