Provider Demographics
NPI:1093973372
Name:LARSON, KENEKE HOPE (MS)
Entity Type:Individual
Prefix:MRS
First Name:KENEKE
Middle Name:HOPE
Last Name:LARSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7315 HIGHWAY 89 S
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-9818
Mailing Address - Country:US
Mailing Address - Phone:501-580-8950
Mailing Address - Fax:
Practice Address - Street 1:7315 HIGHWAY 89 S
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-9818
Practice Address - Country:US
Practice Address - Phone:501-580-8950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP8092235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist