Individual
MARTINA CHANTELLE LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
826 S 1500 E, NAPLES, UT 84078-8609
(435) 781-3100
Mailing address
PO BOX 341, NEOLA, UT 84053-0341
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
9433177-4102
UT
Other
Enumeration date
12/02/2022
Last updated
12/02/2022
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