Provider Demographics
NPI:1700174885
Name:LARSON, KATRINA ELIZABETH (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:ELIZABETH
Last Name:LARSON
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2401 W MAIN ST
Mailing Address - Street 2:AUDIOLOGY DEPT
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959
Mailing Address - Country:US
Mailing Address - Phone:618-997-5311
Mailing Address - Fax:618-998-5656
Practice Address - Street 1:2401 W MAIN ST
Practice Address - Street 2:AUDIOLOGY DEPT
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959
Practice Address - Country:US
Practice Address - Phone:618-997-5311
Practice Address - Fax:618-998-5656
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147.001505231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist