| NPI | 1487238259 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CANDACE R LARSON Speech Language Pathologist 701-500-0104 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist |
| Enumeration Date | 2021-05-07 |
| Last Update Date | 2021-05-07 |