Individual
REBECCA LARSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
908 GRAYCLIFF DR, CALDWELL, ID 83607-1882
(435) 720-2472
Mailing address
908 GRAYCLIFF DR, CALDWELL, ID 83607-1882
(435) 720-2472
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
ID
Other
Enumeration date
07/15/2019
Last updated
07/15/2019
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