Provider Demographics
NPI:1891171278
Name:LARSON, BRANDIE JEAN (MSW, LICSW, LISW)
Entity Type:Individual
Prefix:
First Name:BRANDIE
Middle Name:JEAN
Last Name:LARSON
Suffix:
Gender:F
Credentials:MSW, LICSW, LISW
Other - Prefix:
Other - First Name:BRANDIE
Other - Middle Name:JEAN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:3307 120TH AVE
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:IA
Mailing Address - Zip Code:50047-3253
Mailing Address - Country:US
Mailing Address - Phone:507-236-9569
Mailing Address - Fax:507-399-2159
Practice Address - Street 1:3307 120TH AVE
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:IA
Practice Address - Zip Code:50047-3253
Practice Address - Country:US
Practice Address - Phone:507-236-9569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1119751041C0700X
MN177861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical