Individual
DR. MARLENA LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
1320 WISCONSIN AVE, RACINE, WI 53403-1978
(262) 687-2436
(262) 687-2495
Mailing address
425 4 1/2 MILE RD, RACINE, WI 53402
(262) 456-0206
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2512-057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40959700
—
WI
Enumeration date
09/14/2005
Last updated
11/25/2008
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