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1861718033
LARISA M WILDER
BOULDER, CO
NPI
1861718033
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
235Z00000X Speech-Language Pathologist
(Licence: AZ 12119008)
Enumeration Date
2010-04-13
Last Update Date
2014-01-02
Business Address
LARISA M WILDER CCC-SLP
3825 MONTEREY PLACE
BOULDER, CO 80301
Phone number: 720-536-8948
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Mailing Address
LARISA M WILDER CCC-SLP
3825 MONTEREY PL
BOULDER, CO 80301-1516
Phone number: 720-536-8948
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