Individual
MR. LARRY KAY BRENDTRO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
27843 469TH AVENUE, LENNOX, SD 57039
(605) 580-9557
Mailing address
P.O. BOX 255, LENNOX, SD 57039
(605) 580-9557
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301001648
MI
Other
Enumeration date
10/04/2017
Last updated
10/04/2017
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