Individual
DONNA B LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
3305 N BALLARD RD STE C, APPLETON, WI 54911-9001
(920) 735-9234
Mailing address
6662 OAKRIDGE RD, GREENLEAF, WI 54126-9114
(920) 532-0361
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
318
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42742300
—
WI
Enumeration date
01/29/2007
Last updated
07/09/2007
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