Individual
BROCKEN D LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BCBA, LBA
Contact information
Practice address
10404 S 1055 W, SOUTH JORDAN, UT 84095-1514
(801) 855-9110
Mailing address
191 W 425 S, OGDEN, UT 84404-7349
(385) 439-4446
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
12068508-2506
UT
Other
Enumeration date
03/07/2024
Last updated
03/07/2024
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