Individual
MATTHEW AARON LASSLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
463 S LAKE POWELL BLVD, PAGE, AZ 86040-0856
(928) 645-5113
(928) 645-3254
Mailing address
PO BOX 790, PAGE, AZ 86040-0790
(928) 645-5113
(928) 645-3254
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LAC-17209
AZ
Other
Enumeration date
08/07/2020
Last updated
08/07/2020
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