Individual
LARRA WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1820 BERDAN AVE, TOLEDO, OH 43613-4612
(419) 908-2320
Mailing address
1820 BERDAN AVE, TOLEDO, OH 43613-4612
(419) 908-2320
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
11/26/2024
Last updated
11/26/2024
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