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Individual
MICHAEL A LARSON
Active
Individual
MICHAEL A LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
20823
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20823
LICSW LICENSE
MN
Enumeration date
01/31/2018
Last updated
03/19/2018
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