Provider Demographics
NPI:1851025639
Name:LARSEN, SASHA NICOLE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:NICOLE
Last Name:LARSEN
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 1:1272 SANTA FE CT
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423-8899
Mailing Address - Country:US
Mailing Address - Phone:650-799-8791
Mailing Address - Fax:
Practice Address - Street 1:1565 VIRGINIA RANCH RD
Practice Address - Street 2:
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410-5704
Practice Address - Country:US
Practice Address - Phone:775-782-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-1995235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist