Individual
JAMIE LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1001 W 9TH AVE STE BANDC, KING OF PRUSSIA, PA 19406-1209
(610) 831-1865
Mailing address
2580 LIN DO CT, SUMTER, SC 29150-1832
(803) 905-4427
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
0-12-5109
PA
Other
Enumeration date
05/11/2018
Last updated
05/11/2018
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