Individual
JESSICA LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
453 GRAND AVE, SCHOFIELD, WI 54476-1088
(920) 857-9014
Mailing address
1575 ALLOUEZ AVE, GREEN BAY, WI 54311-5639
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
335-140
WI
Other
Enumeration date
02/04/2020
Last updated
02/04/2020
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