Provider Demographics
NPI:1487867628
Name:LARSON, JAYMIE LEIGH (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JAYMIE
Middle Name:LEIGH
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 1:6293 FORMATION CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-5453
Mailing Address - Country:US
Mailing Address - Phone:702-266-5703
Mailing Address - Fax:
Practice Address - Street 1:6650 W RENO AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1120
Practice Address - Country:US
Practice Address - Phone:702-799-8181
Practice Address - Fax:702-799-8188
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-853235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist