Individual
JACE LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7220 W 41ST ST, SIOUX FALLS, SD 57106-6028
(605) 929-3634
Mailing address
4750 E 54TH ST APT 291, SIOUX FALLS, SD 57110-4473
(605) 929-3634
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
19-105719
SD
Other
Enumeration date
10/13/2020
Last updated
10/13/2020
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