Provider Demographics
NPI:1932365806
Name:LARSON, JULIE D (MSW, LGSW)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:D
Last Name:LARSON
Suffix:
Gender:F
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:D
Other - Last Name:LOCHOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1128 WESTRAC DR S STE A
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-8729
Mailing Address - Country:US
Mailing Address - Phone:701-490-6812
Mailing Address - Fax:855-918-4741
Practice Address - Street 1:1128 WESTRAC DR S STE A
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-8729
Practice Address - Country:US
Practice Address - Phone:701-490-6812
Practice Address - Fax:855-918-4741
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN14981104100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator