Provider Demographics
NPI:1326300427
Name:LARSON, SANDI REED (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SANDI
Middle Name:REED
Last Name:LARSON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11330 Q ST # 226
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-3679
Mailing Address - Country:US
Mailing Address - Phone:402-612-1537
Mailing Address - Fax:
Practice Address - Street 1:11330 Q ST # 226
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-3679
Practice Address - Country:US
Practice Address - Phone:402-612-1537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE973235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist