Individual
ELIZABETH LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
B.S.
Contact information
Practice address
207 LARKSPUR ST, PONDERAY, ID 83852-5011
(208) 610-8652
Mailing address
207 LARKSPUR ST, PONDERAY, ID 83852-5011
(208) 610-8652
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
03/03/2016
Last updated
03/03/2016
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