Individual
ESPERANZA MARLEN LARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3048 S CLIFTON AVE, SPRINGFIELD, MO 65807-5957
(417) 818-5784
Mailing address
1133 S GLENN AVE, SPRINGFIELD, MO 65802-5109
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT222081387669
MO
Other
Enumeration date
02/28/2022
Last updated
02/28/2022
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