Provider Demographics
NPI:1790286235
Name:LARSON, DANIELLE IONE
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:IONE
Last Name:LARSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2595 N CRAMER ST APT 204
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-3914
Mailing Address - Country:US
Mailing Address - Phone:507-995-7356
Mailing Address - Fax:
Practice Address - Street 1:2595 N CRAMER ST APT 204
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-3914
Practice Address - Country:US
Practice Address - Phone:507-995-7356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst