Individual
SHANNON LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
625 STEVENS ST, MEDFORD, OR 97504-6719
(541) 864-1872
Mailing address
625 STEVENS ST, MEDFORD, OR 97504-6719
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
12409
OR
Other
Enumeration date
06/15/2008
Last updated
06/15/2008
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