Individual
JEFFREY DONALD LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
11735 90TH AVE, MILACA, MN 56353-3894
(612) 251-8206
Mailing address
11735 90TH AVE, MILACA, MN 56353-3894
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
300814
MN
Other
Enumeration date
02/25/2019
Last updated
04/15/2021
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