Provider Demographics
NPI:1255659504
Name:LARSON, CATHERINE RENE (ILTYPE 10, LBS1)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:RENE
Last Name:LARSON
Suffix:
Gender:F
Credentials:ILTYPE 10, LBS1
Other - Prefix:MISS
Other - First Name:CATHERINE
Other - Middle Name:RENE
Other - Last Name:BARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1806 W SCHOOL ST
Mailing Address - Street 2:APARTMENT 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-2006
Mailing Address - Country:US
Mailing Address - Phone:773-404-3069
Mailing Address - Fax:
Practice Address - Street 1:1806 W SCHOOL ST
Practice Address - Street 2:APARTMENT 2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-2006
Practice Address - Country:US
Practice Address - Phone:773-404-3069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist