Provider Demographics
NPI:1164496048
Name:LARSON, KARA R (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:R
Last Name:LARSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:LO-367
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-6460
Mailing Address - Fax:617-730-0611
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:LO-367
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-6465
Practice Address - Fax:617-730-0330
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4313235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist