Individual
SUSAN LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1022 PIONEER TRL, BAYPORT, MN 55003-1608
(651) 249-5705
Mailing address
1022 PIONEER TRL, BAYPORT, MN 55003-1608
(651) 249-5705
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
8579
MN
Other
Enumeration date
10/14/2015
Last updated
04/21/2017
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