Individual
JESSICA C LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3425 SUPERIOR AVE, SHEBOYGAN, WI 53081-1863
(920) 496-4700
Mailing address
PO BOX 19070, GREEN BAY, WI 54307-9070
(920) 496-4700
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
12089-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100220019
—
WI
Enumeration date
11/15/2022
Last updated
01/07/2025
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