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1275034969
SAMUEL JEREMIAH LARSON
NAPERVILLE, IL
NPI
1275034969
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
106S00000X Behavior Technician
(Licence: BACB411416)
Enumeration Date
2018-02-27
Last Update Date
2018-02-27
Business Address
SAMUEL JEREMIAH LARSON
603 E DIEHL RD STE 123
NAPERVILLE, IL 60563-4908
Phone number: 331-826-0226
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Mailing Address
SAMUEL JEREMIAH LARSON
21600 OXNARD ST STE 1800
WOODLAND HILLS, CA 91367-7807
Phone number: 818-345-2345
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