Provider Demographics
NPI:1225896541
Name:LARSON, HALEY (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:LARSON
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 CAMPBELL ST N
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:WI
Mailing Address - Zip Code:54021-1018
Mailing Address - Country:US
Mailing Address - Phone:715-821-1783
Mailing Address - Fax:
Practice Address - Street 1:2910 ENLOE ST STE 103
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-4539
Practice Address - Country:US
Practice Address - Phone:715-808-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst