Individual
RAE LARSON
Active
Individual
RAE LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
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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