Individual
JACQUELYN K LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
6000 UNIVERSITY AVE, SUITE 200, WEST DES MOINES, IA 50266-8203
(515) 241-2300
(515) 241-2305
Mailing address
6000 UNIVERSITY AVE, SUITE 200, WEST DES MOINES, IA 50266-8203
(515) 241-2300
(515) 241-2305
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
00558
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1598731986
—
IA
01
—
680012217
RR MEDICARE
IA
Enumeration date
02/24/2006
Last updated
02/23/2010
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