Provider Demographics
NPI:1447398276
Name:LARSON, MEGAN T (SLP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:T
Last Name:LARSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:ROSSIE
Mailing Address - State:IA
Mailing Address - Zip Code:51357-7609
Mailing Address - Country:US
Mailing Address - Phone:712-732-7725
Mailing Address - Fax:712-732-5153
Practice Address - Street 1:315 W 5TH ST
Practice Address - Street 2:
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588-1743
Practice Address - Country:US
Practice Address - Phone:712-732-7725
Practice Address - Fax:712-732-5153
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01761235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist