Individual
LARISA M WILDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
3825 MONTEREY PLACE, BOULDER, CO 80301
(720) 536-8948
(720) 536-8948
Mailing address
3825 MONTEREY PL, BOULDER, CO 80301-1516
(720) 536-8948
(720) 536-8948
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
12119008
AZ
Other
Enumeration date
04/13/2010
Last updated
01/02/2014
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