Provider Demographics
NPI:1578039368
Name:LARSON, JENNA ELIZABETH (MS SLP-CF)
Entity Type:Individual
Prefix:MISS
First Name:JENNA
Middle Name:ELIZABETH
Last Name:LARSON
Suffix:
Gender:F
Credentials:MS SLP-CF
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3960 BELL RD APT 1211
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2957
Mailing Address - Country:US
Mailing Address - Phone:931-247-2486
Mailing Address - Fax:
Practice Address - Street 1:1173 ROCK SPRINGS RD STE 105
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-8414
Practice Address - Country:US
Practice Address - Phone:615-220-5796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist