JEFFERY BLYTHE LARSEN Speech-Language Pathologist License verification

Business Entity

NOT RENEWED

License Type

Speech-Language Pathologist

Description

LICENSED AUDIOLOGIST

License Number

147000763

License Status

NOT RENEWED

Business

First Name

JEFFERY BLYTHE

Last Name

LARSEN

Business Name

JEFFERY BLYTHE LARSEN

Original Issue Date

06/05/1996

Effective Date

10/29/2003

Expiration Date

10/31/2005

City

CHARLESTON

State

Zip

61920

County

COLES

Ever Disciplined

LastModifiedDate

12/22/2005