Larson, Marlena
Larson, Marlena is an individual health care provider with primary practice located at 1320 Wisconsin Ave , Racine WI 53403-1978. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Larson, Marlena can be contacted via phone (262) 687-2436.Contact Information
Primary practice address
1320 Wisconsin Ave
Racine WI 53403-1978
Phone: (262) 687-2436
Fax: (262) 687-2495
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 2512-057 | Wisconsin |
Profile Details
| NPI number | 1538154679 |
|---|---|
| LBN Legal business name | Larson, Marlena |
| Credentials | PSY.D. |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 14th, 2005 |
| Last updated | Nov 25th, 2008 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1538154679 | NPPES |
| Wisconsin | MEDICAID | 40959700 |
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