Individual
LISA LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
535 MOUNTAIN AVE, NEW PROVIDENCE, NJ 07974-2002
(908) 295-5608
Mailing address
47 WHITNEY DR, BERKELEY HEIGHTS, NJ 07922-2515
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
41YS00882400
NJ
Other
Enumeration date
04/29/2017
Last updated
06/14/2017
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