Provider Demographics
NPI:1164315602
Name:LARSON, ANNIKA (MS CF-SLP)
Entity type:Individual
Prefix:
First Name:ANNIKA
Middle Name:
Last Name:LARSON
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 STATEN PL
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-1140
Mailing Address - Country:US
Mailing Address - Phone:317-654-4270
Mailing Address - Fax:
Practice Address - Street 1:8703 HIGHWAY 17 BYP S STE I
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-7701
Practice Address - Country:US
Practice Address - Phone:843-457-1053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist