Provider Demographics
NPI:1225171937
Name:D. JAYNE LARSON ET AL PTR
Entity Type:Organization
Organization Name:D. JAYNE LARSON ET AL PTR
Other - Org Name:THE LIVE OAK CENTER FOR COMMUNICATION DISORDERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:JAYNE
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC-SLP
Authorized Official - Phone:512-453-6778
Mailing Address - Street 1:3724 JEFFERSON ST
Mailing Address - Street 2:SUITE 316
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6222
Mailing Address - Country:US
Mailing Address - Phone:512-453-6778
Mailing Address - Fax:512-453-6995
Practice Address - Street 1:3724 JEFFERSON ST
Practice Address - Street 2:SUITE 316
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6222
Practice Address - Country:US
Practice Address - Phone:512-453-6778
Practice Address - Fax:512-453-6995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty