Individual
DANA LARSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
714 CALLE DON DIEGO, ESPANOLA, NM 87532-3414
(505) 367-3342
Mailing address
714 CALLE DON DIEGO, ESPANOLA, NM 87532-3414
(505) 367-3342
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
C-5787
NM
Other
Enumeration date
10/06/2015
Last updated
10/06/2015
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