Individual
MR. JOHN PAUL LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SAC-IT
Contact information
Practice address
430 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-4172
Mailing address
430 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-4172
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
18138-130
WI
Other
Enumeration date
07/23/2019
Last updated
07/23/2019
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