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1376823526
LARRY JAMES TEDDER
KELSO, WA
NPI
1376823526
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: WA 00001495)
Enumeration Date
2011-08-19
Last Update Date
2019-11-21
Business Address
Mr. LARRY JAMES TEDDER CDP
305 PACIFIC AVE S STE 102
KELSO, WA 98626-1638
Phone number: 360-577-7442
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Mailing Address
Mr. LARRY JAMES TEDDER CDP
PO BOX 1847
LONGVIEW, WA 98632-8140
Phone number: 360-423-0203
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