Provider Demographics
NPI:1538776190
Name:LARSON, TAYLOR MORGAN (SLP)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MORGAN
Last Name:LARSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14663 MERCANTILE DR N
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:MN
Mailing Address - Zip Code:55038-4559
Mailing Address - Country:US
Mailing Address - Phone:651-407-3777
Mailing Address - Fax:651-407-7064
Practice Address - Street 1:4638 VICTOR PATH STE 100
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:MN
Practice Address - Zip Code:55038-4732
Practice Address - Country:US
Practice Address - Phone:651-407-3777
Practice Address - Fax:651-407-7064
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10565235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist