Provider Demographics
NPI:1548573686
Name:LARSEN-STEVOVICH, LAURA LEIGH (SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LEIGH
Last Name:LARSEN-STEVOVICH
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 1:221 BOSTON POST RD. EAST
Mailing Address - Street 2:THOM EARLY INTERVENTION
Mailing Address - City:MARLBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01752
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:221 BOSTON POST RD. EAST
Practice Address - Street 2:SUITE 150 THOM EARLY INTERVENTION
Practice Address - City:MARLBORO
Practice Address - State:MA
Practice Address - Zip Code:01752
Practice Address - Country:US
Practice Address - Phone:508-624-0304
Practice Address - Fax:508-624-0391
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4775235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist