Provider Demographics
NPI:1073945341
Name:LARSEN, REBECCA C (AUD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:C
Last Name:LARSEN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3446
Mailing Address - Street 2:
Mailing Address - City:KAYENTA
Mailing Address - State:AZ
Mailing Address - Zip Code:86033-3446
Mailing Address - Country:US
Mailing Address - Phone:928-697-5134
Mailing Address - Fax:
Practice Address - Street 1:HWY 160 M.P. 394.3
Practice Address - Street 2:
Practice Address - City:KAYENTA
Practice Address - State:AZ
Practice Address - Zip Code:86033
Practice Address - Country:US
Practice Address - Phone:928-697-5134
Practice Address - Fax:928-697-4030
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA8401231HA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner