Provider Demographics
NPI:1528259421
Name:LARSON, PEGGY (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:
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 1:13382 BRYAN RD
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-4907
Mailing Address - Country:US
Mailing Address - Phone:561-790-4940
Mailing Address - Fax:561-790-5760
Practice Address - Street 1:13382 BRYAN RD
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-4907
Practice Address - Country:US
Practice Address - Phone:561-790-4940
Practice Address - Fax:561-790-5760
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 7613235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist