Individual
BRANDON JOHN LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1610 SCRANTON AVE # 81004, PUEBLO, CO 81004-2676
(719) 404-1000
Mailing address
1610 SCRANTON AVE, PUEBLO, CO 81004-2676
(719) 404-1000
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
PSLP.0000174
CO
Other
Enumeration date
08/25/2016
Last updated
07/21/2022
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