Individual
LARA SUSAN HEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
1169
IA
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
2786
WI
Other
Enumeration date
02/05/2009
Last updated
07/08/2016
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