Provider Demographics
NPI:1316207046
Name:LARSON, ERICA (DO)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:
Last Name:LARSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 STATE RD
Mailing Address - Street 2:P.O. BOX 1058
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54602
Mailing Address - Country:US
Mailing Address - Phone:715-227-5401
Mailing Address - Fax:
Practice Address - Street 1:1075 HICKORY ST
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-3022
Practice Address - Country:US
Practice Address - Phone:906-251-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI666562084P0804X
MI51010199032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry