Provider Demographics
NPI:1376862490
Name:LARCHE, KATHLEEN AGNES (EDD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:AGNES
Last Name:LARCHE
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTON
Mailing Address - State:MA
Mailing Address - Zip Code:01746-1346
Mailing Address - Country:US
Mailing Address - Phone:508-429-6959
Mailing Address - Fax:
Practice Address - Street 1:182 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746-1346
Practice Address - Country:US
Practice Address - Phone:508-429-6959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4099235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist