Individual
DEVERY LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
1134 N 500 W, PROVO, UT 84604-3383
(801) 357-7850
Mailing address
1644 N GENEVA RD, PROVO, UT 84601-1288
(801) 636-8106
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
8407056-4102
UT
Other
Enumeration date
08/16/2017
Last updated
08/16/2017
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