Organization
SPROUT PEDIATRIC THERAPY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CANDACE R LARSON MS, CCC-SLP (SPEECH-LANGUAGE PATHOLOGIST)
(701) 500-0104
Entity
Organization
Contact information
Practice address
21 MAIN ST S STE 101A, MINOT, ND 58701-3872
(701) 500-0104
Mailing address
1208 13TH ST SW, MINOT, ND 58701-5784
(701) 500-0104
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
05/07/2021
Last updated
05/07/2021
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