Individual
JESSICA LEE LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
4183 SUNNYSLOPE RD SW, PORT ORCHARD, WA 98367-7677
(360) 443-3503
Mailing address
9160 KRISTI CT NW, BREMERTON, WA 98311-9010
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
60779490
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14074866
AMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION (ASHA)
—
Enumeration date
11/07/2017
Last updated
11/07/2017
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