Individual
NOELLE JANETTE LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MT-BC
Contact information
Practice address
W3566 VANNOY DR, WHITEWATER, WI 53190-3002
(262) 203-6359
Mailing address
W3566 VANNOY DR, WHITEWATER, WI 53190-3002
(262) 203-6359
Taxonomy
Speciality
Code
Description
License number
State
225A00000X
Music Therapist
Primary
12054
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
87-359-7498
IRS
WI
Enumeration date
06/20/2022
Last updated
06/20/2022
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