Provider Demographics
NPI:1518392554
Name:LARSON, MEGAN ANN MARIE (AUD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:ANN MARIE
Last Name:LARSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3857 WOLVERINE ST NE # 16-C
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-4270
Mailing Address - Country:US
Mailing Address - Phone:503-588-1039
Mailing Address - Fax:
Practice Address - Street 1:3857 WOLVERINE ST NE # 16-C
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-4270
Practice Address - Country:US
Practice Address - Phone:503-588-1039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.01949231H00000X
IN23002539A231H00000X
OR030957237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201207720Medicaid
IN000000888978OtherANTHEM
OH0110826Medicaid
IN000000888978OtherANTHEM
OHH296870Medicare PIN