Provider Demographics
NPI:1699215186
Name:LARSON, HANNAH LYDIA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:LYDIA
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 1:5531 COUNTY ROAD 8
Mailing Address - Street 2:
Mailing Address - City:LITTLEFORK
Mailing Address - State:MN
Mailing Address - Zip Code:56653-9126
Mailing Address - Country:US
Mailing Address - Phone:218-417-0251
Mailing Address - Fax:
Practice Address - Street 1:5531 COUNTY RD 8
Practice Address - Street 2:
Practice Address - City:LITTLEFORK
Practice Address - State:MN
Practice Address - Zip Code:56653
Practice Address - Country:US
Practice Address - Phone:218-417-0251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9487235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist