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1619526928
JACK GREGORY LARSEN
TACOMA, WA
NPI
1619526928
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
106S00000X Behavior Technician
Enumeration Date
2019-09-09
Last Update Date
2019-09-09
Business Address
JACK GREGORY LARSEN
4412 6TH AVE
TACOMA, WA 98406-3500
Phone number: 253-285-7180
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Mailing Address
JACK GREGORY LARSEN
21600 OXNARD ST STE 1800
WOODLAND HILLS, CA 91367-7807
Phone number: 818-345-2345
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