Individual
MRS. LARISSA VAN WIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
15116 N COTTON LN, SURPRISE, AZ 85388-9618
(623) 322-8250
(602) 485-8859
Mailing address
15116 N COTTON LN, SURPRISE, AZ 85388-9618
(623) 322-8250
(602) 485-8859
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-21-150641
AZ
Other
Enumeration date
01/07/2021
Last updated
07/03/2024
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