Provider Demographics
NPI:1942283478
Name:LARSON-MOLZEN, ROBIN LAUREE (MED)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:LAUREE
Last Name:LARSON-MOLZEN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 NE BURGANDY CIR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5961
Mailing Address - Country:US
Mailing Address - Phone:816-524-5388
Mailing Address - Fax:
Practice Address - Street 1:1808 NE BURGANDY CIR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-5961
Practice Address - Country:US
Practice Address - Phone:816-524-5388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01735103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist