Provider Demographics
NPI:1669097358
Name:LARSON, KELSEY E (RD)
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:E
Last Name:LARSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-3689
Mailing Address - Country:US
Mailing Address - Phone:715-685-5462
Mailing Address - Fax:715-685-5154
Practice Address - Street 1:1615 MAPLE LN
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-3689
Practice Address - Country:US
Practice Address - Phone:715-685-5462
Practice Address - Fax:715-685-5154
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered