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Individual

MRS. KRISTEN ANNE LARSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MS/CCC-SLP

Contact information

Practice address
3929 N FARWELL AVE, SHOREWOOD, WI 53211-2412
(708) 819-1885
Mailing address
3929 N FARWELL AVE, SHOREWOOD, WI 53211-2412
(708) 819-1885

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
3293-154
WI
235Z00000X
Speech-Language Pathologist
Primary
3293154
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1770810756
WI
Enumeration date
11/11/2009
Last updated
05/27/2022
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