Provider Demographics
NPI:1891474458
Name:ERIKA LARSON SPEECH THERAPY
Entity type:Organization
Organization Name:ERIKA LARSON SPEECH THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLLP
Authorized Official - Phone:906-399-7402
Mailing Address - Street 1:909 S 30TH ST
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-1194
Mailing Address - Country:US
Mailing Address - Phone:906-399-7402
Mailing Address - Fax:
Practice Address - Street 1:2510 1ST AVE N STOP 2
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-1385
Practice Address - Country:US
Practice Address - Phone:906-399-7402
Practice Address - Fax:833-895-1411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-12
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty