Individual
WILLIAM RAYMOND LARRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CCC-SLP
Contact information
Practice address
US HWY 491 NORTH, SHIPROCK, NM 87420
(505) 368-7100
Mailing address
PO BOX 160, SHIPROCK, NM 87420-0160
(505) 368-7100
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1422
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
303220
—
AZ
05
—
56273053
—
CO
05
—
Z1907
—
NM
Enumeration date
03/08/2007
Last updated
09/29/2008
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