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1194731091
DEREK R LARSON
HILL AFB, UT
NPI
1194731091
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: UT 4941733-3501)
Enumeration Date
2006-07-31
Last Update Date
2024-12-03
Business Address
DEREK R LARSON LCSW
75TH MEDICAL GROUP 7321 BALMER STREET BUILDING 570
HILL AFB, UT 84056
Phone number: 801-777-7909
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Mailing Address
DEREK R LARSON LCSW
75TH MEDICAL GROUP 7321 BALMER STREET BUILDING 570
HILL AFB, UT 84056
Phone number: 801-777-7909
Copy
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