Provider Demographics
NPI:1770810756
Name:LARSON, KRISTEN ANNE (MS/CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:ANNE
Last Name:LARSON
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:MISS
Other - First Name:KRISTEN
Other - Middle Name:ANNE
Other - Last Name:KAMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS/CCC-SLP
Mailing Address - Street 1:3929 N FARWELL AVE
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-2412
Mailing Address - Country:US
Mailing Address - Phone:708-819-1885
Mailing Address - Fax:
Practice Address - Street 1:3929 N FARWELL AVE
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-2412
Practice Address - Country:US
Practice Address - Phone:708-819-1885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3293-154235Z00000X
WI3293154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1770810756Medicaid