Individual
JEROME ALLEN LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSS
Contact information
Practice address
3090 N 53RD ST, MILWAUKEE, WI 53210-1617
(414) 254-4291
Mailing address
3090 N 53RD ST, MILWAUKEE, WI 53210-1617
(414) 254-4291
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
10/22/2019
Last updated
10/22/2019
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