Provider Demographics
NPI:1114202413
Name:LARSEN, ALLYSON MARIE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:ALLYSON
Middle Name:MARIE
Last Name:LARSEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 KAY DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:IA
Mailing Address - Zip Code:52322-9260
Mailing Address - Country:US
Mailing Address - Phone:507-525-4546
Mailing Address - Fax:
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:C124 GH
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-353-6860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007878104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker