Individual
SUSAN LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1020 35TH STREET, KENOSHA, WI 53140
(262) 767-6487
Mailing address
1020 35TH STREET, KENOSHA, WI 53140-1902
(262) 767-6487
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
3633-29
WI
133V00000X
Registered Dietitian
Primary
812643
IL
Other
Enumeration date
01/30/2023
Last updated
01/30/2023
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