Provider Demographics
NPI:1699048330
Name:LARSON, KARA MARIE (MA,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KARA
Middle Name:MARIE
Last Name:LARSON
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7111A ANTIOCH RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:12850-2417
Mailing Address - Country:US
Mailing Address - Phone:518-785-0222
Mailing Address - Fax:518-785-8801
Practice Address - Street 1:38 DUNSBACH FERRY RD
Practice Address - Street 2:
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047-5016
Practice Address - Country:US
Practice Address - Phone:518-785-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010644-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist