Individual
RAE LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
7280 NW 87TH TER STE C, KANSAS CITY, MO 64153-3720
(314) 686-7997
(314) 686-7998
Mailing address
447 TAMARACH DR, EDWARDSVILLE, IL 62025-5243
(314) 686-7997
(314) 686-7998
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
20220002656
MO
1041C0700X
Clinical Social Worker
Primary
—
—
1041S0200X
School Social Worker
2600972
IL
Other
Enumeration date
09/27/2023
Last updated
08/23/2024
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