Active NPI
Blake Larkowski
- Speech-Language Pathologist
- Poplar Bluff, MO
National Provider Identifier
1619489796
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 2016002604
- Practice address
- 1110 N Westwood Blvd
Poplar Bluff, MO 63901-3336 - Phone
- (573) 785-7751
- NPI assigned
- Oct 30, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 2016002604 | MO | Primary |
Addresses
Primary practice location
1110 N Westwood Blvd
Poplar Bluff, MO 63901-3336
Mailing address
1110 N Westwood Blvd
Poplar Bluff, MO 63901-3336
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2016002604 | MO | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1509321600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1509321600000",
"number": "1619489796",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1110 N WESTWOOD BLVD",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639013336"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1110 N WESTWOOD BLVD",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639013336",
"telephone_number": "573-785-7751"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARKOWSKI",
"first_name": "BLAKE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-10-30",
"last_updated": "2017-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MO",
"license": "2016002604",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Poplar Bluff, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.