Individual
KOURTNEY LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5214 CHEDWORTH DR, CHARLOTTE, NC 28210-3704
(207) 323-1276
Mailing address
5214 CHEDWORTH DR, CHARLOTTE, NC 28210-3704
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
10836
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10836
NORTH CAROLINA BOARD OF EXAMINERS SLP
NC
Enumeration date
04/17/2014
Last updated
08/04/2014
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