Provider Demographics
NPI:1922270388
Name:LARSON, TONYA B (LISW)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:B
Last Name:LARSON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 KENYON RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5718
Mailing Address - Country:US
Mailing Address - Phone:515-573-3138
Mailing Address - Fax:515-573-3130
Practice Address - Street 1:409 KENYON RD
Practice Address - Street 2:SUITE C
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5718
Practice Address - Country:US
Practice Address - Phone:515-573-3138
Practice Address - Fax:515-573-3130
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA006451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical