Provider Demographics
NPI:1457696726
Name:LARSON, DANIELLE NICOLE (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:NICOLE
Last Name:LARSON
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:N
Other - Last Name:HOPWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:314 SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:SPOONER
Mailing Address - State:WI
Mailing Address - Zip Code:54801-6200
Mailing Address - Country:US
Mailing Address - Phone:715-635-2518
Mailing Address - Fax:715-635-2672
Practice Address - Street 1:314 SERVICE RD
Practice Address - Street 2:
Practice Address - City:SPOONER
Practice Address - State:WI
Practice Address - Zip Code:54801-6200
Practice Address - Country:US
Practice Address - Phone:715-635-2518
Practice Address - Fax:866-245-8064
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3667-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
K400156172Medicare PIN