Individual
EMILY LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
988 N ILLINOIS ROUTE 3, WATERLOO, IL 62298-1059
(618) 939-4444
Mailing address
PO BOX 146, WATERLOO, IL 62298-0146
(618) 939-4444
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
104100000X
Social Worker
2021023587
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2021023587
LMSW
MO
Enumeration date
08/19/2021
Last updated
03/29/2023
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