Provider Demographics
NPI:1134455009
Name:LARSON, ANDREA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
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 1:4356 FALLS LAKE DR SW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-0028
Mailing Address - Country:US
Mailing Address - Phone:570-991-0217
Mailing Address - Fax:
Practice Address - Street 1:140 CABARRUS AVE W
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025
Practice Address - Country:US
Practice Address - Phone:704-239-6321
Practice Address - Fax:844-708-0619
Is Sole Proprietor?:No
Enumeration Date:2009-10-27
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist