Provider Demographics
NPI:1972980357
Name:LARSON, ASHILEE ANN (LSW)
Entity Type:Individual
Prefix:
First Name:ASHILEE
Middle Name:ANN
Last Name:LARSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2291
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58802-2291
Mailing Address - Country:US
Mailing Address - Phone:701-577-0270
Mailing Address - Fax:
Practice Address - Street 1:1102 7TH AVE E
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-4450
Practice Address - Country:US
Practice Address - Phone:701-572-7262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4372104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker