Provider Demographics
NPI:1730114000
Name:LARSON, DIONE (LP)
Entity Type:Individual
Prefix:
First Name:DIONE
Middle Name:
Last Name:LARSON
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 BANDANA BLVD E
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-5113
Mailing Address - Country:US
Mailing Address - Phone:651-642-2700
Mailing Address - Fax:651-642-9441
Practice Address - Street 1:1295 BANDANA BLVD N
Practice Address - Street 2:SUITE 142
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-5126
Practice Address - Country:US
Practice Address - Phone:651-641-7062
Practice Address - Fax:651-641-7196
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3090103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist