Provider Demographics
NPI:1639841513
Name:LARSON, KATHRYN (LADC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:LARSON
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 WASHINGTON AVE S APT 716
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1451
Mailing Address - Country:US
Mailing Address - Phone:515-370-4646
Mailing Address - Fax:
Practice Address - Street 1:620 BABCOCK BLVD E
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328-8603
Practice Address - Country:US
Practice Address - Phone:612-354-6818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)