MEDICARE: ASPEN LARKINS 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
1	235Z00000X	Speech-Language Pathologist	SA15834	FL
2	235Z00000X	Speech-Language Pathologist	SLP010803	GA
3	235Z00000X	Speech-Language Pathologist	29593	CA

General Provider Information

NPI Number	:	1902426117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASPEN LARKINS CCC-SLP

Provider Business Mailing Address
First Line	:	2770 NW 174TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-4033
Country	:	US
Telephone Number	:	305-300-4346
Fax Number	:

Provider Business Practice Location Address
First Line	:	2770 NW 174TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-4033
Country	:	US
Telephone Number	:	305-300-4346
Fax Number	:

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

Provider Enumeration Date	:	04/17/2020
Last Update Date	:	04/17/2020

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Directions to “ ASPEN LARKINS CCC-SLP” Practice Location

Language	Start Address	Practice Location

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