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NPI Code Detail

MEDICARE: MAIRA LARA AMBRIS SLP

MEDICARE: MAIRA LARA AMBRIS SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language PathologistPRD-SP-LIC-12708MT

General Provider Information

NPI Number : 1073107702
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAIRA LARA AMBRIS SLP
Provider Business Mailing Address
First Line : 9 14TH AVE W
Second Line :
City : POLSON
State : MT
Zip : 59860-5321
Country : US
Telephone Number : 406-883-4378
Fax Number :
Provider Business Practice Location Address
First Line : 9 14TH AVE W
Second Line :
City : POLSON
State : MT
Zip : 59860-5321
Country : US
Telephone Number : 406-883-4378
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2021
Last Update Date : 06/03/2026

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Directions to “ MAIRA LARA AMBRIS SLP” Practice Location

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