MEDICARE: KATIE LARUE

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

General Provider Information

NPI Number	:	1881181725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE LARUE

Provider Business Mailing Address
First Line	:	132 N MAIN ST
Second Line	:
City	:	FAIR GROVE
State	:	MO
Zip	:	65648-8436
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	132 N MAIN ST
Second Line	:
City	:	FAIR GROVE
State	:	MO
Zip	:	65648-8436
Country	:	US
Telephone Number	:	417-759-2555
Fax Number	:

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

Provider Enumeration Date	:	04/17/2018
Last Update Date	:	04/17/2018

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Directions to “ KATIE LARUE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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